ROOSEVELT LEWIS III (NPI# 1649798133) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649798133 |
| Entity Type | Individual |
| Full Name | ROOSEVELT LEWIS III |
| Credential | NP |
| Practice Address |
1486 Dorchester Ave Ste 206 Boston MA 02122 |
| Mailing Address |
1486 Dorchester Ave Ste 206 Boston MA 02122-1344 |
| Practice Telephone | 6174017441 |
| Practice Fax Number | 6172036651 |
| Mailing Telephone | 6174017441 |
| Mailing Fax Number | 6172036651 |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2018-11-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | RN2313246 | MA | Nursing Service Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
RN2313246 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 320 Flint St Apt 1, Fall River, MA 02723 | (508) 232-0196 |
| Street Address |
1486 DORCHESTER AVE STE 206 |
| City | BOSTON |
| State | MA |
| Zip Code | 02122 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033720875 | Joey Mark Nguyen | Pharmacist | 747 Gallivan Blvd, Dorchester, MA 02122 | 2020-08-14 |
| 1518575240 | Hamilton Pharmacy LLC | Pharmacy | 246 Bowdoin St, Dorchester, MA 02122 | 2020-07-20 |
| 1336789528 | Katheline Leconte | Social Worker | 230 Bowdoin Street, Dorchester, MA 02122 | 2020-01-15 |
| 1700374725 | Renee Ahern | Registered Nurse | 398 Neponset Ave., Dorchester, MA 02122 | 2018-04-25 |
| 1861902371 | Bridget Mary Walsh | Specialist/Technologist | 519 Ashmont St, Dorchester, MA 02122 | 2017-10-10 |
| 1811427404 | Hanh Nguyen | Counselor | 50 Redfield St, Suite 300, Dorchester, MA 02122 | 2017-06-15 |
| 1669902474 | Thuy T Nguyen | Counselor | 415 Neponset Avenue, Dorchester, MA 02122 | 2017-06-14 |
| 1093262651 | David Scot Rapaport | Counselor | 1452 Dorchester Avenue, Fcbl-4, Boston, MA 02122 | 2016-09-01 |
| 1104372960 | Kevin Lyn Sisson | Student in an Organized Health Care Education/Training Program | 417 Neponset Ave, Boston, MA 02122 | 2016-08-31 |
| 1891171021 | Shannon K Mullen | Registered Nurse | 20 Thelma Rd, Dorchester, MA 02122 | 2015-08-11 |
| Find all providers in zip 02122 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376153494 | Melissa Broughton | Nurse Practitioner | 110 Salem St Apt 4, Boston, MA 02113-1763 | 2020-08-04 |
| 1780239483 | Dallas Michelle Ducar | Nurse Practitioner | 55 Fruit St Fl Hall4, Boston, MA 02114-2696 | 2019-08-08 |
| 1295258259 | Joseph F Toomey IIi | Nurse Practitioner | 48 Melrose St., Boston, MA 02116-2409 | 2017-07-21 |
| 1871950733 | Rebecca Donadio | Nurse Practitioner | 84 State Stareet, Suite 660, Boston, MA 02109-2200 | 2016-01-24 |
| 1811320559 | Alexandra Paige Libon Strack | Nurse Practitioner | 10 Newbury St Fl 4, Boston, MA 02116-3290 | 2013-08-16 |
| 1174806046 | Donald L Payette Jr. | Nurse Practitioner | 40 River St Unit 208, Boston, MA 02126-2983 | 2011-09-27 |
| 1134759665 | Sokhira Christina Yang | Nurse Practitioner | Boston Medical Center, 88 E Newton Street, Boston, MA 02118 | 2020-01-23 |
| 1730661042 | Brittany Catherine Hughes | Nurse Practitioner | 800 Washington St, Boston, MA 02111-1552 | 2018-09-04 |
| 1528549425 | Adekemi Victoria Adeleye | Nurse Practitioner | 1 Boston Medical Center Place, Boston, MA 02118 | 2018-08-28 |
| 1174022693 | Ally Integrated Healthcare LLC | Nurse Practitioner | 30 Newbury St Ste 3, Boston, MA 02116-3239 | 2018-02-10 |
| Find all providers in BOSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.