Provider Demographics
NPI:1093786733
Name:LEE, MARVIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:S
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:176 DENISON PKWY E
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2814
Practice Address - Country:US
Practice Address - Phone:607-937-7278
Practice Address - Fax:607-937-7860
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113108-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018676990002Medicaid
NY00373139Medicaid
NYCC8362OtherRR MEDICARE GROUP
NY050083222OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
PA0018676990002Medicaid