Provider Demographics
NPI:1588665178
Name:LEE, TONY T (MD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:T
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 1:640 S. STATE STREET
Mailing Address - Street 2:MAIL CODE 3055
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-480-1688
Mailing Address - Fax:302-480-9807
Practice Address - Street 1:640 S STATE ST FL 1
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-674-4401
Practice Address - Fax:302-674-4129
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00130252085R0001X, 2085R0001X
CAG846742085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQMP000003837403OtherMOLINA MCD
FL0286653OtherCIGNA
FL149W1OtherBCBS FL
FL1670928OtherGHI
FL662343OtherWELLCARE
FL01415057OtherAMERIGROUP
FL20091OtherMEDICA HEALTH
FL341111OtherAVMED
FL7110015OtherAETNA
FLP0003154OtherFLORIDA HEALTHCARE PLUS
FLQMP000003837409OtherMOLINA MCR
FL002813800Medicaid
IN920004728Medicare PIN
FL7110015OtherAETNA
FL002813800Medicaid
IN132510HMedicare PIN
G23980Medicare UPIN
ING23980Medicare UPIN