Provider Demographics
NPI:1083615462
Name:LEE, PRESCOTT P (MD)
Entity Type:Individual
Prefix:DR
First Name:PRESCOTT
Middle Name:P
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:701 MAIDEN CHOICE LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5968
Mailing Address - Country:US
Mailing Address - Phone:410-402-2257
Mailing Address - Fax:410-402-2264
Practice Address - Street 1:100 BROOKSBY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1438
Practice Address - Country:US
Practice Address - Phone:978-536-7850
Practice Address - Fax:978-536-7051
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY231263207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083615462OtherBCBS
0430282OtherEVERCARE
MA110084444AMedicaid
522239464OtherTRICARE
P00408803Medicare PIN
1083615462OtherBCBS
522239464OtherTRICARE