Provider Demographics
NPI:1992804462
Name:LEWIS, PAMELA P (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:P
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ONE SHRADER ST.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1035
Mailing Address - Country:US
Mailing Address - Phone:415-668-8060
Mailing Address - Fax:415-668-8064
Practice Address - Street 1:ONE SHRADER ST.
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1035
Practice Address - Country:US
Practice Address - Phone:415-668-8060
Practice Address - Fax:415-668-8064
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG51040208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G51040Medicare ID - Type Unspecified
CAA89929Medicare UPIN