Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 046855 | CT |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 046855 | CT |
NPI | 1598717779 |
---|---|
Provider Name | Mark Tsu Chong Lee |
First Address | Hartford, CT 06106-3322 |
Second Address | Hartford, CT 06106-3322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 06/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050447454 | CORPORATE FEDERAL ID # (01) |