Provider Demographics
NPI:1003805243
Name:LEE, SANGHEE ROSE (DO)
Entity Type:Individual
Prefix:DR
First Name:SANGHEE
Middle Name:ROSE
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 W ONTARIO ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5220
Mailing Address - Country:US
Mailing Address - Phone:215-707-9403
Mailing Address - Fax:215-225-1698
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:800-836-7536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236291207R00000X
PAOS014484207R00000X
VA0102202577207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022631010002Medicaid
NY1821048612OtherGROUP NPI NUMBER
NY1003805243OtherNPI NUMBER
PA1022631010001Medicaid
PA2093179OtherHIGHMARK BLUE SHIELD
PA2093179OtherHIGHMARK BLUE SHIELD
NY1821048612OtherGROUP NPI NUMBER
139880VYNMedicare PIN
NYSL01542S10Medicare PIN