Provider Demographics
NPI:1003836768
Name:LEE, MENG-CHAO (DO)
Entity Type:Individual
Prefix:
First Name:MENG-CHAO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:2ND TPI
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-926-9010
Mailing Address - Fax:215-226-8285
Practice Address - Street 1:7500 CENTRAL AVE STE 104
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2431
Practice Address - Country:US
Practice Address - Phone:215-742-0712
Practice Address - Fax:215-742-5218
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS012030207QH0002X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI15630Medicare UPIN