Provider Demographics
NPI:1639140122
Name:LEE, MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MARYLAND RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1225
Mailing Address - Country:US
Mailing Address - Phone:215-481-4143
Mailing Address - Fax:215-481-6790
Practice Address - Street 1:501 STREET RD STE 101
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3796
Practice Address - Country:US
Practice Address - Phone:215-357-5780
Practice Address - Fax:215-364-8983
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI35068Medicare UPIN
PA092983Medicare PIN