Provider Demographics
NPI:1578692018
Name:LEE LEWIS, DARA K (MD)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:K
Last Name:LEE LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DARA
Other - Middle Name:K
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:21 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5239
Mailing Address - Country:US
Mailing Address - Phone:617-732-1318
Mailing Address - Fax:617-734-5763
Practice Address - Street 1:21 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5239
Practice Address - Country:US
Practice Address - Phone:617-732-1318
Practice Address - Fax:617-734-5763
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20020342207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM35722517Medicaid
NMNM301017Medicare PIN
NM349304503Medicare PIN
NM349304504Medicare PIN
NM35722517Medicaid
G52199Medicare UPIN
348235002Medicare PIN