Provider Demographics
NPI:1942282280
Name:LEWIS, MARK S (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:800 WASHINGTON STREET
Mailing Address - Street 2:#298
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-5000
Mailing Address - Fax:617-636-1465
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:#298
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-5000
Practice Address - Fax:617-636-1465
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2017-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA55261207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA613824OtherHARVARD PILGRIM HEALTHCAR
MA3050297Medicaid
MA82971OtherAETNA US HEALTHCARE
MA5586023OtherAETNA
MA055261OtherTUFTS HEALTHPLAN
MA2000005OtherUNITED HEALTHCARE
MAJ05103LEOtherBLUE CROSS/SHIELD MA
MA5586023OtherAETNA
MAD72365Medicare UPIN