1295780302 NPI number — CLAUDIA E LEE M.D.

Table of content: CLAUDIA E LEE M.D. (NPI 1295780302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295780302 NPI number — CLAUDIA E LEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
CLAUDIA
Provider Middle Name:
E
Provider Name Prefix Text:
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:
1295780302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
156 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTPELIER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05602-2924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-223-1222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 CLARENDON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTPELIER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05602-2119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-223-3557
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2006

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: 207R00000X , with the licence number:  042-0009953 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 54235 . This is a "CIGNA VENDOR #" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 05540 . This is a "MVP VENDOR #" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 042-0009953 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: OVN2135 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111-48663 . This is a "BC/BS PROVIDER NUMBER" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 542350 . This is a "CIGNA PROVIDER #" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 11094 . This is a "MVP PROVIDER #" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 43--111127330-01 . This is a "STATE EIN" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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