Provider Demographics
NPI:1467619106
Name:LEE, JONATHAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
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:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-1327
Mailing Address - Country:US
Mailing Address - Phone:603-524-3211
Mailing Address - Fax:603-527-7038
Practice Address - Street 1:14 MAPLE STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-6578
Practice Address - Country:US
Practice Address - Phone:603-528-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237818207X00000X
NH16181207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHT400107761Medicare UPIN
NYA400031617Medicare PIN