Provider Demographics
NPI:1558514315
Name:LEE, JULIE (DPM)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CBOC-WPS
Mailing Address - Street 2:377 PLANTATION ST.
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:413-584-4040
Mailing Address - Fax:
Practice Address - Street 1:377 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2245
Practice Address - Country:US
Practice Address - Phone:972-399-9280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1108213E00000X
TX1873213E00000X
MA2315213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201332807Medicaid
TX201332804Medicaid
TXP01192557OtherRAILROAD MEDICARE
TX2013328Medicaid
TX201332806Medicaid
TX8L11348Medicare PIN
TX283259YPT7Medicare PIN
TX283259YPREMedicare PIN
TX201332806Medicaid