1063581742 NPI number — DR. LESLEY H LEE M.D.

Table of content: DR. LESLEY H LEE M.D. (NPI 1063581742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063581742 NPI number — DR. LESLEY H LEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
LESLEY
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063581742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 N 7TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17046-5040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-273-1710
Provider Business Mailing Address Fax Number:
717-273-1416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
128 N GEORGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17401-1117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-848-6116
Provider Business Practice Location Address Fax Number:
717-848-6215
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  0101055993 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: MD056801L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010039550 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1024620520002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 189534 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 299066 . This is a "AMERIGROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 546001103002 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0072 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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