1235113358 NPI number — GEORGE LEE MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235113358 NPI number — GEORGE LEE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
GEORGE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1235113358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
318 WATERMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-438-5950
Provider Business Mailing Address Fax Number:
401-435-2561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 WATERMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-438-5950
Provider Business Practice Location Address Fax Number:
401-435-2561
Provider Enumeration Date:
12/01/2005

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: 207RN0300X , with the licence number:  9792 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X , with the licence number: 157469 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9792 . This is a "BLUECROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: A28436 . This is a "MEDI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 10242 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3100092 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3726392 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4131470002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: J19110 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2361 . This is a "NEIGHBORHOOD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 390005807 . This is a "RAILROAD MEDI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 790769 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 402862 . This is a "BLUECHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 7006431 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110060109A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000033673 . This is a "BOSTON MECIDAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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