Provider Demographics
NPI:1679545446
Name:LEE, ELLEN LYMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:LYMAN
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 STATION AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2092
Mailing Address - Country:US
Mailing Address - Phone:207-373-6848
Mailing Address - Fax:207-373-6849
Practice Address - Street 1:22 STATION AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2092
Practice Address - Country:US
Practice Address - Phone:207-373-6848
Practice Address - Fax:207-373-6849
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016522207Q00000X
RIMD07436207Q00000X
MA70463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5536582OtherCIGNA
P00139414OtherRAILROAD MEDICARE
3569097OtherAETNA
ME406990099Medicaid
047645OtherANTHEM
AA23786OtherHARVARD PILGRIM
E69469Medicare UPIN
P00139414OtherRAILROAD MEDICARE