Provider Demographics
NPI:1629096193
Name:LEE, ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-8016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1320 MAPLEWOOD AVE STE A
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-8016
Practice Address - Country:US
Practice Address - Phone:304-647-1175
Practice Address - Fax:304-647-3807
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1243208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV004303000Medicaid
WV020022430OtherRAILROAD MEDICARE
WV350033OtherMAMSI
WV60015OtherSOUTHERN HEALTH
WV282380OtherANTHEM BCBS
WV026OtherMTST BCBS
WV4502219OtherAETNA
WV406972002OtherCIGNA
WV282380OtherANTHEM BCBS
0754350001Medicare NSC
WV350033OtherMAMSI