Provider Demographics
NPI:1417912791
Name:LEE, JANICE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 MAIN ST
Mailing Address - Street 2:HARTFORD GYN CENTER
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-1806
Mailing Address - Country:US
Mailing Address - Phone:806-525-1900
Mailing Address - Fax:856-414-1660
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:HARTFORD GYN CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1806
Practice Address - Country:US
Practice Address - Phone:806-525-1900
Practice Address - Fax:856-414-1660
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT020580207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT163223OtherFRIST CHOICE
CTP751454OtherOXFOTORD
CTC59934Medicare UPIN