Provider Demographics
NPI:1497741946
Name:LEE, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9120
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02027-9120
Mailing Address - Country:US
Mailing Address - Phone:781-329-1400
Mailing Address - Fax:781-278-5667
Practice Address - Street 1:325 RIVER RIDEGE DRIVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-329-1400
Practice Address - Fax:781-278-5667
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA71648208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
61231OtherHARVARD/PILGRIM
753034OtherTUFTS BENEFIT ADMIN
01-04903OtherUNITED HEALTHCARE(PPO)
753034OtherTUFTS COMMONWEALTH PPO
753034OtherTUFTS TOTAL HEALTH PLAN
J10918OtherBLUE SHIELD-INDEMITY
0016062OtherNEIGHBORHOOD HEALTH PLAN
0448593OtherHEALTHSOURCE MASS
E80158OtherFIRST SENIORITY
3076555OtherMASS HEALTH(DIV OF MED)
753034OtherTUFTS
61231OtherHARVARD PILGRIM POS
0448593OtherCIGNA HEALTH CARE
27592OtherCHILDREN'S MEDICAL
61231OtherHARVARD PILGRIM PPO
J10918OtherHMO BLUE/BLUE CHOICE
753034OtherTUFTS COMMONWEALTH PPO