Provider Demographics
NPI:1841244126
Name:J. T. LEE, MD, PA
Entity Type:Organization
Organization Name:J. T. LEE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-939-2840
Mailing Address - Street 1:669 REVOLUTION ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3319
Mailing Address - Country:US
Mailing Address - Phone:410-939-2840
Mailing Address - Fax:410-939-2329
Practice Address - Street 1:669 REVOLUTION ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3319
Practice Address - Country:US
Practice Address - Phone:410-939-2840
Practice Address - Fax:410-939-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020661174400000X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Not Answered302R00000XManaged Care OrganizationsHealth Maintenance Organization