Provider Demographics
NPI:1689667958
Name:MADDOX, LEE (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:MADDOX
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2465
Mailing Address - Fax:717-741-3043
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8200
Practice Address - Country:US
Practice Address - Phone:717-851-2465
Practice Address - Fax:717-741-3043
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421102207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA271453OtherUNISON-WMG
PA001940725Medicaid
MD904415OtherCAREFIRST MD BCBS
PA1459910OtherHIGHMARK BLUE SHEILD
PA1534399OtherGATEWAY-WMG
PA20087293OtherAMERIHEALTH MERCY-WMG
PA20087293OtherAMERIHEALTH MERCY-WMG
PAP00741874Medicare PIN
PA001940725Medicaid