Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 231263 | NY |
NPI | 1083615462 |
---|---|
Provider Name | Dr. Prescott P Lee |
First Address | Baltimore, MD 21228-5968 |
Second Address | Peabody, MA 01960-1438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 19/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0430282 | EVERCARE (01) | |
1083615462 | BCBS (01) | |
110084444A | (05) | MA |
522239464 | TRICARE (01) | |
G71866 | (02) |