Provider Demographics
NPI:1003917626
Name:LEE, JONATHAN M (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
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 1:64 PLYMOUTH DR
Mailing Address - Street 2:APT. #1-B
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-6413
Mailing Address - Country:US
Mailing Address - Phone:617-522-4400
Mailing Address - Fax:
Practice Address - Street 1:49 ROBINWOOD AVENUE
Practice Address - Street 2:ARBOUR HOSPITAL
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-522-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72678207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine