Provider Demographics
NPI:1255308466
Name:LEE, KATHERINE D (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:D
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01061-1177
Mailing Address - Country:US
Mailing Address - Phone:413-586-8443
Mailing Address - Fax:413-586-8443
Practice Address - Street 1:30 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2052
Practice Address - Country:US
Practice Address - Phone:413-582-2105
Practice Address - Fax:413-582-2059
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA39384207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-3319155OtherCONSOLIDATED
MA04-3319155OtherNORTHEAST HEALTH DIRECT
MA04-3319155OtherNORTHEAST HEALTHCARE ALLI
MA2045184Medicaid
MA04-3319155OtherNORTH AMERICAN PREFERRED
MA04-3319155OtherPLAN VISTA
MA18208OtherHEALTH NEW ENGLAND
MA000000020112OtherBMC
MA2061OtherHARVARD PILGRIM
MA04-3319155OtherUNICARE-GIC
MA0467423OtherAETNA
MA4714023OtherCIGNA
MA39884OtherCONNECTICARE
B72998Medicare UPIN
MAA21378Medicare PIN