Provider Demographics
NPI:1477500304
Name:LEE, TAT- SUM (MD)
Entity Type:Individual
Prefix:DR
First Name:TAT- SUM
Middle Name:
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 1:3898 VINEYARD DR
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-3559
Mailing Address - Country:US
Mailing Address - Phone:716-363-2233
Mailing Address - Fax:716-363-2237
Practice Address - Street 1:3898 VINEYARD DR
Practice Address - Street 2:SUITE 3
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-3559
Practice Address - Country:US
Practice Address - Phone:716-363-1515
Practice Address - Fax:716-363-7677
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6407025OtherINDEPENDENT HEALTH
NY000507408002OtherBLUE CROSS BLUE SHIELD
NY00600702Medicaid
NY00010102203OtherUNIVERA
NY00600702Medicaid
NY6407025OtherINDEPENDENT HEALTH