Provider Demographics
NPI:1437148772
Name:LEE, KATHRYN Y (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:Y
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:Y
Other - Last Name:HIGASHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3735
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-1210
Practice Address - Street 1:100 MEDWAY RD
Practice Address - Street 2:SUITE 204
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2923
Practice Address - Country:US
Practice Address - Phone:508-482-5444
Practice Address - Fax:508-482-5408
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0170241Medicaid
MA0170241Medicaid
MAH60239Medicare UPIN