1346401312 NPI number — DR. ANDY M LEE M.D.

Table of content: DR. ANDY M LEE M.D. (NPI 1346401312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346401312 NPI number — DR. ANDY M LEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
ANDY
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1346401312
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BETH ISRAEL DEACONESS MEDICAL CENTER
Provider Second Line Business Mailing Address:
DIVISION OF VASCULAR AND ENDOVASCULAR SURGERY SUITE 5B
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-598-9355
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
61 LINCOLN ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01702-8264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-598-9355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2008

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: 2086S0129X , with the licence number:  FL262317 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 236902 , 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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