Provider Demographics
NPI:1235314907
Name:LEWIS, HEATHER (MD, MPH, MS)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD, MPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6139 OXON HILL RD # 1184
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3108
Mailing Address - Country:US
Mailing Address - Phone:760-576-4707
Mailing Address - Fax:
Practice Address - Street 1:6139 OXON HILL RD # 1184
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3108
Practice Address - Country:US
Practice Address - Phone:760-576-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00958342083P0901X, 2083P0500X, 261QP2300X
VA39020000X207R00000X
VA01012461322083P0901X, 2083P0500X, 261QP2300X, 2865M2000X
CAA1596252083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital