Provider Demographics
NPI:1316933179
Name:MADARANG-LEWIS, JOY (MD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:MADARANG-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 1:1405 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-7232
Mailing Address - Country:US
Mailing Address - Phone:410-546-2115
Mailing Address - Fax:410-546-2362
Practice Address - Street 1:1405 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-7232
Practice Address - Country:US
Practice Address - Phone:410-546-2115
Practice Address - Fax:410-546-2362
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050929207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD461980300Medicaid
MDD0050929OtherLICENSE
MD521492901OtherTAX ID
MD521492901OtherTAX ID
MDG38192Medicare UPIN