Provider Demographics
NPI:1679689442
Name:LEE, ELSIE S (MD)
Entity Type:Individual
Prefix:DR
First Name:ELSIE
Middle Name:S
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 1:1200 S CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6202
Mailing Address - Country:US
Mailing Address - Phone:610-402-8140
Mailing Address - Fax:610-402-1691
Practice Address - Street 1:HEALTH NETWORK LABORATORIES
Practice Address - Street 2:1200 SOUTH CEDAR CREST BOULEVARD
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103
Practice Address - Country:US
Practice Address - Phone:610-402-8140
Practice Address - Fax:610-402-1691
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052961L207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G05480Medicare UPIN
DC007701M83Medicare ID - Type Unspecified