Provider Demographics
NPI:1972573277
Name:LEE, RUSSELL D (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:D
Last Name:LEE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:15 S MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6626
Mailing Address - Country:US
Mailing Address - Phone:716-483-1183
Mailing Address - Fax:716-664-4903
Practice Address - Street 1:15 S MAIN ST
Practice Address - Street 2:SUITE 170
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6626
Practice Address - Country:US
Practice Address - Phone:716-483-1183
Practice Address - Fax:716-664-4903
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2016-02-18
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Provider Licenses
StateLicense IDTaxonomies
NY258146208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03338612Medicaid
NYJ400168929OtherMEDICARE PTAN