Provider Demographics
NPI:1285740159
Name:LEWIS, ELIZABETH A (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MID ATLANTIC ANESTHESIA CONSULTANTS PLLC
Mailing Address - Street 2:P. O. BOX 711841
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-0001
Mailing Address - Country:US
Mailing Address - Phone:304-346-9400
Mailing Address - Fax:304-345-7320
Practice Address - Street 1:1200 J D ANDERSON DR
Practice Address - Street 2:MID ATLANTIC ANESTHESIA CONSULTANTS, PLLC
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3494
Practice Address - Country:US
Practice Address - Phone:304-346-9400
Practice Address - Fax:304-345-7320
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1972207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVDA0096OtherRR MEDICARE
WV001757382OtherMSBCBS
WV3003594000Medicaid
WV0207026000Medicaid
WV27005299701OtherWORKERS COMP
WV27005299700OtherWORKERS COMP
WV270052997004OtherTRICARE
WV9364011OtherMEDICARE GROUP AAP
WVP00142950OtherRR MEDICARE
WV20554238700OtherBRICKSTREET GROUP
WV0014706469OtherMSBCBS GROUP
WV1070944OtherBRICKSTREET
WV2022544OtherALLIANCE
WV001757382OtherMSBCBS
WVDA0096OtherRR MEDICARE
WV3003594000Medicaid