Provider Demographics
NPI:1629040647
Name:DENNIS, LEE MONROE (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:MONROE
Last Name:DENNIS
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 1:960 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3470
Mailing Address - Country:US
Mailing Address - Phone:302-735-1888
Mailing Address - Fax:302-735-1802
Practice Address - Street 1:960 FOREST ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3470
Practice Address - Country:US
Practice Address - Phone:302-735-1888
Practice Address - Fax:302-735-1802
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0002705208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE149408Medicare PIN