Provider Demographics
NPI:1336164839
Name:LEE-POWELL, ROBERTA F (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:F
Last Name:LEE-POWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MARKET STREET
Mailing Address - Street 2:LM 500 WEST TOWER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2100
Mailing Address - Country:US
Mailing Address - Phone:215-985-2595
Mailing Address - Fax:
Practice Address - Street 1:1200 CALLOWHILL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3658
Practice Address - Country:US
Practice Address - Phone:215-825-8220
Practice Address - Fax:215-825-8254
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005603L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0104270003OtherAMERICHOICE
PA001042730001Medicaid
PA1010001OtherKEYSTONE MERCY
PA19749OtherAETNA
PA02895OS005603LOtherHEALTH PARTNERS
PA0058413000OtherKEYSTONE HEALTH PLAN EAST
PA0104270003OtherAMERICHOICE
PA077607JQSMedicare Oscar/Certification