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| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Darrell Lewis | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States | [sources] | |||
| Description | License No: D76104 | [sources] | |||
| First name | Darrell | [sources] | |||
| Last name | Lewis | [sources] | |||
| NPI | 1265752414 | [sources] | |||
| Sector | MD | [sources] | |||
| Address | 5 GARRETT AVENUE, LA PLATA, MD 20648 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers deemed ineligible to participate in Maryland's Medicaid program.
United States of America · MDH
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