Provider Demographics
NPI:1295780302
Name:LEE, CLAUDIA E (MD)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:E
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2924
Mailing Address - Country:US
Mailing Address - Phone:802-223-1222
Mailing Address - Fax:
Practice Address - Street 1:55 CLARENDON AVE
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2119
Practice Address - Country:US
Practice Address - Phone:802-223-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0009953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT54235OtherCIGNA VENDOR #
VT05540OtherMVP VENDOR #
VT042-0009953OtherSTATE LICENSE NUMBER
VTOVN2135Medicaid
VT111-48663OtherBC/BS PROVIDER NUMBER
VT542350OtherCIGNA PROVIDER #
VT11094OtherMVP PROVIDER #
VT43--111127330-01OtherSTATE EIN
VT54235OtherCIGNA VENDOR #
VT111-48663OtherBC/BS PROVIDER NUMBER
VT542350OtherCIGNA PROVIDER #