Provider Demographics
NPI:1396717013
Name:LEWIS, DANA MARIE (DO)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
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:PO BOX 604308
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-4308
Mailing Address - Country:US
Mailing Address - Phone:804-273-8014
Mailing Address - Fax:855-858-0464
Practice Address - Street 1:3372 LAURENS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5236
Practice Address - Country:US
Practice Address - Phone:864-537-4600
Practice Address - Fax:855-858-0464
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100716207P00000X
CO53354207Q00000X
CA20A7088207Q00000X
SC93933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46401873Medicaid
CA00AX70880Medicaid
CA201502856OtherEIN NUMBER
CA00AX70880Medicaid
CA020A70882Medicare ID - Type Unspecified