Provider Demographics
NPI:1003884677
Name:TEE, DAVID FOWLER (M D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FOWLER
Last Name:TEE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:380 PLEASANT ST
Mailing Address - Street 2:SUITE 1-1
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-8123
Mailing Address - Country:US
Mailing Address - Phone:781-324-9100
Mailing Address - Fax:781-397-1345
Practice Address - Street 1:380 PLEASANT ST
Practice Address - Street 2:SUITE 1-1
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-8123
Practice Address - Country:US
Practice Address - Phone:781-324-9100
Practice Address - Fax:781-397-1345
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38628207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2051737Medicaid
MAB27151OtherBCBS OF MA.
MA706181OtherTUFTS
MA706181OtherTUFTS