Provider Demographics
NPI:1588762611
Name:LEWIS, KARL C
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:C
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CARROLL AND TATE STREETS
Mailing Address - Street 2:CALL BOX 3600
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266
Mailing Address - Country:US
Mailing Address - Phone:276-883-8000
Mailing Address - Fax:276-889-4336
Practice Address - Street 1:58 CARROLL AND TATE STREETS
Practice Address - Street 2:CALL BOX 3600
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266
Practice Address - Country:US
Practice Address - Phone:276-883-8000
Practice Address - Fax:276-889-4336
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034533207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1588762611Medicaid
KY64027030Medicaid
VA1588762611Medicaid
KY64027030Medicaid