Basic Information
Provider Information
NPI: 1780674309
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEWIS
FirstName: NOREEN
MiddleName: P
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 W ELM ST
Address2:  
City: CONSHOHOCKEN
State: PA
PostalCode: 194282007
CountryCode: US
TelephoneNumber: 6105676964
FaxNumber: 6105676170
Practice Location
Address1: 5630 CHESTNUT ST
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191393232
CountryCode: US
TelephoneNumber: 2157483100
FaxNumber: 2157481586
Other Information
ProviderEnumerationDate: 10/25/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XOS012302PAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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