Provider Demographics
NPI:1851504880
Name:LEE G DANTE MDPA
Entity Type:Organization
Organization Name:LEE G DANTE MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:DANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-667-5448
Mailing Address - Street 1:321 BERKELEY RD
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1403
Mailing Address - Country:US
Mailing Address - Phone:610-667-5488
Mailing Address - Fax:610-667-8117
Practice Address - Street 1:321 BERKELEY RD
Practice Address - Street 2:
Practice Address - City:MERION STATION
Practice Address - State:PA
Practice Address - Zip Code:19066-1403
Practice Address - Country:US
Practice Address - Phone:610-667-5488
Practice Address - Fax:610-667-8117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014206E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD525681000Medicaid
PA998300Medicaid
MD604PMedicare PIN
PAC-31624Medicare UPIN
MD525681000Medicaid
MDC31624Medicare UPIN
PA604PMedicare PIN