Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS015870 | PA |
N | 207QA0505X | Family Doctor - Adult Medicine | 25MB09360100 | NJ |
NPI | 1306144514 |
---|---|
Provider Name | Dr. Mark Lee |
First Address | Philadelphia, PA 19182-9641 |
Second Address | Buckingham, PA 18912-0278 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2011 |
Last Update Date | 15/01/2019 |