Provider Demographics
NPI:1942351424
Name:ROSENBAUM, LEE ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ROBERT
Last Name:ROSENBAUM
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 1:1330 BEACON ST STE 255
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3200
Mailing Address - Country:US
Mailing Address - Phone:617-731-2689
Mailing Address - Fax:
Practice Address - Street 1:1330 BEACON ST STE 255
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3200
Practice Address - Country:US
Practice Address - Phone:617-731-2689
Practice Address - Fax:617-739-2139
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA378082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3013961Medicaid
MAM09118Medicare PIN
MA3013961Medicaid