Basic Information
| Provider Information | |||||||||
| NPI: | 1144328535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | LYDIA | ||||||||
| MiddleName: | DEE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1514 JEFFERSON HWY | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701212429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048424000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4845 MAIN ST | ||||||||
| Address2: | SUITE D | ||||||||
| City: | ZACHARY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707913943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257615200 | ||||||||
| FaxNumber: | 2257545063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 05/03/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 15313R | LA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 841703313 | 01 | LA | BENEFIT MANAGEMENT | OTHER | 841703313 | 01 | LA | AETNA | OTHER | H3655 | 01 | LA | BLUE CROSS BLUE SHIELD | OTHER | 841703313 | 01 | LA | CIGNA | OTHER | 841703313 | 01 | LA | HUMANA | OTHER | 1175064 | 05 | LA | MEDICAID | 841703313 | 01 | LA | UNITED HEALTH CARE | OTHER | 09823702 | 05 | MS | MEDICAID | 841703313 | 01 | LA | STATE GROUP | OTHER | 841703313 | 01 | LA | FARA | OTHER | 841703313 | 01 | LA | COVENTRY | OTHER | 841703313 | 01 | LA | TRICARE | OTHER |