Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2006-01310 | NC |
N | 208600000X | Surgeon | 2006-01310 | NC |
Y | 208200000X | Surgeon | MD438913 | PA |
Y | 208600000X | Surgeon | MD438913 | PA |
NPI | 1003090911 |
---|---|
Provider Name | Meng-G Martin Lee |
First Address | Butler, PA 16001-4780 |
Second Address | Butler, PA 16001-4780 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2007 |
Last Update Date | 18/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (02) |