Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | C1-0012649 | DE |
N | 2080P0205X | Pediatric Endocrinologist | 70464 | MA |
NPI | 1225011349 |
---|---|
Provider Name | Dr. Mary Min-Chin Lee |
First Address | Rockland, DE 19732-0191 |
Second Address | Worcester, MA 01655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 22/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110049041A | (05) | MA |