Provider Demographics
NPI:1275633562
Name:LEE, DAVID CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:520 STOKES ROAD
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2904
Mailing Address - Country:US
Mailing Address - Phone:609-714-7774
Mailing Address - Fax:609-714-7775
Practice Address - Street 1:520 STOKES ROAD
Practice Address - Street 2:SUITE A-4
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2904
Practice Address - Country:US
Practice Address - Phone:609-714-7774
Practice Address - Fax:609-714-7775
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ498172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2385960OtherAETNA
NJ130023199OtherRAILROAD MEDICARE
NJ130023199OtherRAILROAD MEDICARE
NJE13943Medicare UPIN