Provider Demographics
NPI:1033172077
Name:LEE, MARCIANO B (MD)
Entity Type:Individual
Prefix:
First Name:MARCIANO
Middle Name:B
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:UNIVERSITY OF KENTUCKY 900 S LIMESTONE CTW 326
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-8040
Mailing Address - Fax:859-323-0295
Practice Address - Street 1:UNIVERSITY OF KENTUCKY 900 S LIMESTONE CTW 326
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536
Practice Address - Country:US
Practice Address - Phone:859-323-8040
Practice Address - Fax:859-323-0295
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP696207RC0000X
WVWV 18125207RC0000X
KY51514207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0086281000Medicaid
WVP01051335Medicare PIN
WV0831515Medicare ID - Type UnspecifiedCHARLESTON LOCATION
WV0086281000Medicaid
WV0831514Medicare ID - Type UnspecifiedCHAPMANVILLE LOCATION
WVWV1439AMedicare PIN