Provider Demographics
NPI:1043409782
Name:WALTER J LEE MD PC
Entity Type:Organization
Organization Name:WALTER J LEE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-254-7473
Mailing Address - Street 1:280 WASHINGTON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3511
Mailing Address - Country:US
Mailing Address - Phone:617-254-7473
Mailing Address - Fax:617-254-3141
Practice Address - Street 1:280 WASHINGTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3511
Practice Address - Country:US
Practice Address - Phone:617-254-7473
Practice Address - Fax:617-254-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM16298OtherBLUE CROSS GROUP
MAM20016OtherMEDICARE GROUP
MA604026OtherTUFT GROUP
MA9775994Medicaid
MAX01776Medicare UPIN