Provider Demographics
NPI:1255543997
Name:LEWIS, CORALEE INETA (MD)
Entity type:Individual
Prefix:
First Name:CORALEE
Middle Name:INETA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
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 5135
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823
Mailing Address - Country:US
Mailing Address - Phone:340-692-6717
Mailing Address - Fax:
Practice Address - Street 1:4500 SION FARM
Practice Address - Street 2:SUITE 5 ISLAND MEDICAL CENTER
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-692-6717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI10832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E01339Medicare ID - Type Unspecified
E01339Medicare UPIN