Provider Demographics
NPI:1972561371
Name:LEWIS, BENJAMIN FRANKLIN (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:FRANKLIN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:B
Other - Middle Name:FRANKLIN
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:761 SELDON DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3240
Mailing Address - Country:US
Mailing Address - Phone:540-667-7945
Mailing Address - Fax:540-533-0805
Practice Address - Street 1:761 SELDON DRIE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-667-7945
Practice Address - Fax:540-533-1686
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033000207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0083436000Medicaid
VA006095747Medicaid
110000958OtherRAILROAD MEDICARE
VA006095747Medicaid
VA110003757Medicare PIN
110000958Medicare PIN