Provider Demographics
NPI:1679568034
Name:PERSON, DONALD LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LEWIS
Last Name:PERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:740 E STATE ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3328
Practice Address - Country:US
Practice Address - Phone:724-983-7310
Practice Address - Fax:724-983-2797
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.048139207L00000X
PAMD435769207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010901000006Medicaid
OH0614633Medicaid
OH000000594277OtherANTHEM BCBS
PA000777135OtherHIGHMARK BCBS
PA138640ZB29OtherMEDICARE PTAN
PAP00689370OtherMEDICARE RAILROAD
PA000777135OtherHIGHMARK BCBS