Provider Demographics
NPI:1104810266
Name:PHILLIPS, LEWIS EVERETT (MD)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:EVERETT
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 MOUNT HOPE AVE
Mailing Address - Street 2:STE 11
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4236
Mailing Address - Country:US
Mailing Address - Phone:207-947-0128
Mailing Address - Fax:207-947-0205
Practice Address - Street 1:336 MOUNT HOPE AVE
Practice Address - Street 2:STE 11
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4236
Practice Address - Country:US
Practice Address - Phone:207-947-0128
Practice Address - Fax:207-947-0205
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME6085207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
111132712OtherRAILROAD MEDICARE
ME304680099Medicaid
ME003955OtherANTHEM
ME304680099Medicaid
D03832Medicare UPIN