Provider Demographics
NPI:1215034020
Name:LEE, CHRISTOPHER JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOSEPH
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:30 BALDWIN BLVD
Practice Address - Street 2:
Practice Address - City:SHAMOKIN DAM
Practice Address - State:PA
Practice Address - Zip Code:17876-9519
Practice Address - Country:US
Practice Address - Phone:570-884-7970
Practice Address - Fax:570-884-7975
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101731067 0001Medicaid
PA1475996OtherBLUE SHIELD GROUP
PA1475996OtherKEYSTONE GROUP
PA50016191OtherBLUE CROSS GROUP
PA15761540005Medicaid
PA210181OtherH.A. IND
PA82215OtherGHP INDIVIDUAL
PALE1899782OtherBLUE SHIELD
PA106134RY9Medicare PIN
PA210181OtherH.A. IND
PADC7049Medicare ID - Type UnspecifiedGROUP RR MEDICARE
PAP00366996Medicare ID - Type UnspecifiedIND RR MEDICARE
PA101731067 0001Medicaid