Provider Demographics
NPI:1831466176
Name:GRANT, LEE (LMT)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:GRANT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 DEPOT ST
Mailing Address - Street 2:PO BOX 462
Mailing Address - City:BAR MILLS
Mailing Address - State:ME
Mailing Address - Zip Code:04004-0462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39 DEPOT ST
Practice Address - Street 2:
Practice Address - City:BAR MILLS
Practice Address - State:ME
Practice Address - Zip Code:04004-0462
Practice Address - Country:US
Practice Address - Phone:207-284-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT2153174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist