Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | OS012030 | PA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OS012030 | PA |
NPI | 1003836768 |
---|---|
Provider Name | Meng-Chao Lee |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19111-2431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 14/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I15630 | (02) | PA |