Provider Demographics
NPI: | 1700237203 |
---|---|
Name: | DAVID LEE MD LLC |
Entity Type: | Organization |
Organization Name: | DAVID LEE MD LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PSYCHIATRIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | LEE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 267-702-0447 |
Mailing Address - Street 1: | 1420 WALNUT ST |
Mailing Address - Street 2: | SUITE 1412 |
Mailing Address - City: | PHILADELPHIA |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19102-4017 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 267-702-0447 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1420 WALNUT ST |
Practice Address - Street 2: | SUITE 1412 |
Practice Address - City: | PHILADELPHIA |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19102-4017 |
Practice Address - Country: | US |
Practice Address - Phone: | 267-702-0447 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-06-26 |
Last Update Date: | 2016-06-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD446627 | 102L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 102L00000X | Behavioral Health & Social Service Providers | Psychoanalyst | Group - Single Specialty |