Provider Demographics
NPI:1003090911
Name:LEE, MENG-G MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:MENG-G MARTIN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4780
Mailing Address - Country:US
Mailing Address - Phone:724-431-4190
Mailing Address - Fax:
Practice Address - Street 1:480 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4780
Practice Address - Country:US
Practice Address - Phone:724-431-4190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01310208600000X
PAMD438913208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare UPIN