Provider Demographics
NPI:1962421404
Name:LEWIS, PETER JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JAMES
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3655
Mailing Address - Country:US
Mailing Address - Phone:401-467-4740
Mailing Address - Fax:
Practice Address - Street 1:1050 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3655
Practice Address - Country:US
Practice Address - Phone:401-467-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00180213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAS00691460001OtherCIGNA
RI2700193OtherUNITED HEALTH OF NEW ENGL
RI4000717OtherBLUECHIP OF RI
RI7011-5OtherBCBS OF RI
RI7000818Medicaid
RI7011OtherFEDERAL EMPLOYEE PROGRAM
RIAS00691460001OtherCIGNA