Provider Demographics
NPI:1558498352
Name:LEE, PAUL C (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
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 1:309 TEATICKET HWY
Mailing Address - Street 2:
Mailing Address - City:TEATICKET
Mailing Address - State:MA
Mailing Address - Zip Code:02536-5625
Mailing Address - Country:US
Mailing Address - Phone:508-540-6790
Mailing Address - Fax:508-548-1932
Practice Address - Street 1:309 TEATICKET HWY
Practice Address - Street 2:
Practice Address - City:TEATICKET
Practice Address - State:MA
Practice Address - Zip Code:02536-5625
Practice Address - Country:US
Practice Address - Phone:508-540-6790
Practice Address - Fax:508-548-1932
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE05605OtherBLUE CROSS BLUE SHIELD
MA9726861Medicaid
MAE05605Medicare ID - Type Unspecified
MA9726861Medicaid