Provider Demographics
NPI:1205846151
Name:LEE, PETER HONGKYUN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:HONGKYUN
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 1:2527 CRANBERRY HWY
Mailing Address - Street 2:PROVIDER RELATIONS DEPT.
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1046
Mailing Address - Country:US
Mailing Address - Phone:800-841-5200
Mailing Address - Fax:508-273-1241
Practice Address - Street 1:41 MALL RD LAHEY HOSPITAL AND MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-2961
Practice Address - Country:US
Practice Address - Phone:781-744-8170
Practice Address - Fax:781-744-5232
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2268192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11721437OtherCAQH
MA110075779AMedicaid
MAS400358019Medicare PIN
MA290901Medicare PIN
11721437OtherCAQH