Provider Demographics
NPI:1073613097
Name:LEE, GRACE M (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:LAHEY CLINIC
Mailing Address - Street 2:41 MALL ROAD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8170
Mailing Address - Fax:781-744-5232
Practice Address - Street 1:LAHEY CLINIC
Practice Address - Street 2:41 MALL ROAD
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-8170
Practice Address - Fax:781-744-5232
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA752832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3096131Medicaid
MA3096131Medicaid
MAJ12833Medicare PIN