Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2170 | MA |
NPI | 1033191481 |
---|---|
Provider Name | Dr. Sammy Lee |
First Address | Charlestown, PA 02129-9142 |
Second Address | Boston, MA 02114-2696 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0326810 | (05) | MA |
408713 | TUFTS HEALTH PLAN (01) | MA |
U86497 | (02) | |
Y71090 | BCBS MA (01) | MA |