Provider Demographics
NPI:1114965811
Name:DOUGLAS LEE MD INC
Entity Type:Organization
Organization Name:DOUGLAS LEE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-233-8431
Mailing Address - Street 1:221 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-4754
Mailing Address - Country:US
Mailing Address - Phone:440-244-0010
Mailing Address - Fax:440-244-0726
Practice Address - Street 1:1930 REID AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-3771
Practice Address - Country:US
Practice Address - Phone:440-233-8431
Practice Address - Fax:440-233-8432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty