Provider Demographics
NPI:1417517855
Name:LEE, ANNA JAYOUNG ' (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:JAYOUNG '
Last Name: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 1:31 ROCHE BROS WAY STE 140
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1032
Mailing Address - Country:US
Mailing Address - Phone:508-894-8730
Mailing Address - Fax:508-894-0412
Practice Address - Street 1:31 ROCHE BROS WAY
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1038
Practice Address - Country:US
Practice Address - Phone:508-894-8730
Practice Address - Fax:508-894-0412
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2024-01-12
Deactivation Date:2020-01-27
Deactivation Code:
Reactivation Date:2020-02-11
Provider Licenses
StateLicense IDTaxonomies
PAMT217594390200000X
390200000X
MA295453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program