Provider Demographics
NPI:1285773366
Name:LEWIS, ANN J (MD, PHD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD, PHD
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 LAWRENCE EXPY
Mailing Address - Street 2:HOMESTEAD MOB, DEPT 190; TPMG PEDIATRICS
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5173
Mailing Address - Country:US
Mailing Address - Phone:408-851-9896
Mailing Address - Fax:408-851-1199
Practice Address - Street 1:710 LAWRENCE EXPY
Practice Address - Street 2:HOMESTEAD MOB, DEPT 190; TPMG PEDIATRICS
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5173
Practice Address - Country:US
Practice Address - Phone:408-851-9896
Practice Address - Fax:408-851-1199
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA72730208000000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A727300Medicaid
CAI12711Medicare UPIN
CA00A727300Medicaid