Provider Demographics
NPI:1366406167
Name:LEW, CHRISTOPHER YOUNG (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:YOUNG
Last Name:LEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 CRYSTAL CT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5093
Mailing Address - Country:US
Mailing Address - Phone:985-639-8265
Mailing Address - Fax:
Practice Address - Street 1:1850 GAUSE BLVD E
Practice Address - Street 2:SUITE 201
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5442
Practice Address - Country:US
Practice Address - Phone:985-649-5825
Practice Address - Fax:985-645-0884
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14529174400000X
LAMD.10231R208VP0014X
LA10231R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA173801000OtherWORKERS COMP
LA173801000OtherWORKERS COMP
LAF70922Medicare UPIN