Provider Demographics
NPI:1720183304
Name:LEE, LAWRENCE W (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:W
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 1:285 PROMENADE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-5719
Mailing Address - Country:US
Mailing Address - Phone:401-459-4001
Mailing Address - Fax:401-459-4006
Practice Address - Street 1:285 PROMENADE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-5719
Practice Address - Country:US
Practice Address - Phone:401-459-4001
Practice Address - Fax:401-459-4006
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07767207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI405946OtherBLUE CHIP
RI0900561OtherUNITED
RI20992OtherBLUE CROSS
RI6155420001Medicare NSC
RI0900561OtherUNITED
RIF13150Medicare UPIN