Provider Demographics
NPI:1801001466
Name:LEE, ROGER P (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:P
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 1:23625 COMMERCE PARK
Mailing Address - Street 2:STE 204
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-255-5700
Mailing Address - Fax:216-255-5701
Practice Address - Street 1:5475 N WOODS LN
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-1199
Practice Address - Country:US
Practice Address - Phone:862-703-1149
Practice Address - Fax:216-255-5701
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0882602085R0202X
OH35-0882602085R0202X
NY2362422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200262420AMedicaid
PA1022518530001Medicaid
OK200262420AMedicaid