Provider Demographics
NPI:1801831276
Name:SIMERMAN, LEE PAUL (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:PAUL
Last Name:SIMERMAN
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 1:800 SPRUCE ST
Mailing Address - Street 2:2 SCHIEDT
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6130
Mailing Address - Country:US
Mailing Address - Phone:215-829-3201
Mailing Address - Fax:215-829-5697
Practice Address - Street 1:800 SPRUCE ST
Practice Address - Street 2:PAH 2 SHEIDT
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6130
Practice Address - Country:US
Practice Address - Phone:215-829-3201
Practice Address - Fax:215-829-5697
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028100E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011055710021Medicaid
PA0011055710021Medicaid
PA447695Medicare PIN