Provider Demographics
NPI:1598717779
Name:LEE, MARK TSU CHONG (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:TSU CHONG
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TSU
Other - Middle Name:CHONG
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:282 WASHINGTON ST
Mailing Address - Street 2:SUITE 1H, DEPARTMENT OF ORTHOPAEDICS
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3322
Mailing Address - Country:US
Mailing Address - Phone:860-545-8643
Mailing Address - Fax:860-545-9095
Practice Address - Street 1:282 WASHINGTON ST
Practice Address - Street 2:SUITE 1H, DEPARTMENT OF ORTHOPAEDICS
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-545-8643
Practice Address - Fax:860-545-9095
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046855207XP3100X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
050447454OtherCORPORATE FEDERAL ID #