Provider Demographics
NPI:1063993889
Name:LEWIS, BAILEY E (ATC)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:E
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2614
Mailing Address - Country:US
Mailing Address - Phone:269-319-9216
Mailing Address - Fax:
Practice Address - Street 1:566 BROWNSON RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21402-5006
Practice Address - Country:US
Practice Address - Phone:269-319-9216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0000955207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine