Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 134322 | NY |
Y | 207N00000X | Dermatologist | MD043612L | PA |
NPI | 1013981059 |
---|---|
Provider Name | Dr. Rachel D. Lee |
First Address | Sayre, PA 18840-1625 |
Second Address | Sayre, PA 18840-1625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 14/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0016226870004 | (05) | PA |
00810628 | (05) | NY |
D02247 | (02) | |
GU039820 | PA MEDICARE GROUP (01) | PA |
P00289349 | RR MEDICARE (01) | PA |