Provider Demographics
NPI:1619974102
Name:ALBERT, LEE S (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:S
Last Name:ALBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:258 MAIN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2525
Mailing Address - Country:US
Mailing Address - Phone:508-473-2321
Mailing Address - Fax:508-473-2327
Practice Address - Street 1:258 MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2525
Practice Address - Country:US
Practice Address - Phone:508-473-2321
Practice Address - Fax:508-473-2327
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA59085207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ11110OtherBLUE CROSS BLUE SHIELD
MAJ11110Medicare PIN
MAJ11110OtherBLUE CROSS BLUE SHIELD