Provider Demographics
NPI:1558350934
Name:LEE, TSAPMAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:TSAPMAN
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:T.JACK
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3 WOODLAND RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1702
Mailing Address - Country:US
Mailing Address - Phone:781-662-0604
Mailing Address - Fax:781-665-4162
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:SUITE 312
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1702
Practice Address - Country:US
Practice Address - Phone:781-662-0604
Practice Address - Fax:781-665-4162
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50267174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6176623Medicaid
MA6176623Medicaid
MAJ02956Medicare ID - Type Unspecified