Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 31859 | MA |
NPI | 1013980291 |
---|---|
Provider Name | Dr. James Richard Lee |
First Address | Charlestown, MA 02129-9142 |
Second Address | Winthrop, MA 02152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2056461 | (05) | MA |
706340 | TUFTS HEALTH PLAN (01) | MA |
B98270 | (02) | |
K19077 | BCBS MA (01) | MA |