Provider Demographics
NPI:1326023904
Name:SIRACUSE-LEE, DONNA (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:SIRACUSE-LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 BAY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-1085
Mailing Address - Country:US
Mailing Address - Phone:508-823-7473
Mailing Address - Fax:508-824-3830
Practice Address - Street 1:2005 BAY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-1085
Practice Address - Country:US
Practice Address - Phone:508-823-7473
Practice Address - Fax:508-824-3830
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231777207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2144697Medicaid
MAJ42615OtherBLUE CROSS BLUE SHIELD
MA0002263OtherMEDICARE
MAAA103842OtherHARVARD PILGRIM
MAH66592Medicare UPIN