Provider Demographics
NPI:1235113358
Name:LEE, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
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 1:318 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914
Mailing Address - Country:US
Mailing Address - Phone:401-438-5950
Mailing Address - Fax:401-435-2561
Practice Address - Street 1:318 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914
Practice Address - Country:US
Practice Address - Phone:401-438-5950
Practice Address - Fax:401-435-2561
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI9792207RN0300X
MA157469207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9792OtherBLUECROSS
MAA28436OtherMEDI
10242OtherHARVARD PILGRIM
3100092OtherUNITED
3726392OtherAETNA
4131470002OtherCIGNA
MAJ19110OtherBLUE CROSS
2361OtherNEIGHBORHOOD
390005807OtherRAILROAD MEDI
790769OtherTUFTS
RI402862OtherBLUECHIP
RI7006431Medicaid
MA110060109AMedicaid
MA000000033673OtherBOSTON MECIDAL
790769OtherTUFTS
MAA28436OtherMEDI
MAA28436Medicare PIN