Individual
GARY WILLIAM LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1265 WAYNE AVE STE 306, INDIANA, PA 15701-3501
(724) 463-9701
(724) 463-9702
Mailing address
640 KOLTER DR, INDIANA, PA 15701-3570
(724) 357-7196
(724) 357-7279
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD040211L
PA
207RC0000X
Cardiovascular Disease Physician
D0059982
MD
207RC0000X
Cardiovascular Disease Physician
Primary
MD040211L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007307260040
MEDICAID GROUP #
PA
01
—
110868
JOHNS HOPKINS HEALTHCARE
MD
01
—
145744300
US DEPT OF LABOR
—
01
—
1759448
UNITED HEALTHCARE
MD
05
—
2007547000
—
WV
01
—
3536055
AETNA HMO
MD
01
—
3979804
CIGNA
MD
05
—
402544000
—
MD
01
—
5121416
MAMSI
MD
01
—
5127062
AETNA PPO
MD
01
—
63366502
BC/BS
MH
01
—
867633
MEDICARE GROUP #
PA
01
—
B3890008
BC/BS
DC
Enumeration date
11/11/2005
Last updated
04/13/2021
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