Provider Demographics
NPI:1780677310
Name:LEE, A SEENAM (MD)
Entity Type:Individual
Prefix:
First Name:A SEENAM
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:A.
Other - Middle Name:S
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2143 WEST PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004
Mailing Address - Country:US
Mailing Address - Phone:440-992-4499
Mailing Address - Fax:440-992-8013
Practice Address - Street 1:2143 WEST PROSPECT RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004
Practice Address - Country:US
Practice Address - Phone:440-992-4499
Practice Address - Fax:440-992-8013
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2010-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039158L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH351346510003OtherMEDICAL MUTUAL
OH000000143121OtherANTHEM
OH0505260Medicaid
OH000000143121OtherANTHEM
OHLE0523111Medicare PIN