Provider Demographics
NPI:1689637944
Name:LEE, UHUN RO (MD)
Entity Type:Individual
Prefix:
First Name:UHUN
Middle Name:RO
Last Name:LEE
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 1:45 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2858
Mailing Address - Country:US
Mailing Address - Phone:508-580-0044
Mailing Address - Fax:508-587-0350
Practice Address - Street 1:45 PEARL ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2858
Practice Address - Country:US
Practice Address - Phone:508-580-0044
Practice Address - Fax:508-587-0350
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40044207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA92910OtherAETNA
MAJ03194OtherBLUE SHIELD
MA2047063Medicaid
MA13020OtherHARVARD PILGRIM
MA040044OtherTUFTS HEALTH PLAN
MA000000007252OtherBOSTON HEALTH NET PLAN
MA0004321OtherNEIGHBORHOOD HEALTH
MA0701045OtherUNITED HEALTHCARE
MA040044OtherTUFTS HEALTH PLAN
MAA56949Medicare UPIN