Provider Demographics
NPI:1609852177
Name:LEE, SUSANNE NUSSEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:NUSSEN
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:3805 W CHESTER PIKE BLDG D
Practice Address - Street 2:SUITE 120
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2329
Practice Address - Country:US
Practice Address - Phone:800-257-0117
Practice Address - Fax:610-550-3079
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0008614207ZD0900X
PAMD421782207ZP0102X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11517014OtherCAQH