Provider Demographics
NPI:1831117829
Name:LEE, JANICE RENAE (DO)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:RENAE
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:RENAE
Other - Last Name:MANCOTTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:31 STILES RD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2897
Mailing Address - Country:US
Mailing Address - Phone:603-894-0500
Mailing Address - Fax:603-894-0535
Practice Address - Street 1:31 STILES RD
Practice Address - Street 2:SUITE 2100
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2897
Practice Address - Country:US
Practice Address - Phone:603-894-0500
Practice Address - Fax:603-894-0535
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1680207Q00000X
NH16317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP01287452OtherRAILROAD MEDICARE
NH3091343Medicaid
ME1831117829OtherNPI
NHP01287452OtherRAILROAD MEDICARE
H24041Medicare UPIN
NH3091343Medicaid