1235265919 NPI number — EUDOCIA QUANT LEE MD

Table of content: EUDOCIA QUANT LEE MD (NPI 1235265919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235265919 NPI number — EUDOCIA QUANT LEE MD

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
QUANT
Provider Other First Name:
EUDOCIA
Provider Other Middle Name:
CARMEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235265919
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 BROOKLINE AVENUE, SW 460C
Provider Second Line Business Mailing Address:
DANA FARBER CANCER INSTITUTE
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02115-5418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-632-2166
Provider Business Mailing Address Fax Number:
617-632-4773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 BROOKLINE AVENUE
Provider Second Line Business Practice Location Address:
DANA FARBER CANCER INSITUTE
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115-5418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-632-2166
Provider Business Practice Location Address Fax Number:
617-632-4773
Provider Enumeration Date:
02/26/2007

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: 2084N0400X , with the licence number:  231319 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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