Provider Demographics
NPI:1356312151
Name:LEE, FERROL J (MD)
Entity type:Individual
Prefix:DR
First Name:FERROL
Middle Name:J
Last Name:LEE
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:317 W LOCKHART ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1618
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:570-887-3035
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129616-1207RE0101X
PAMD029322E207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009251070001Medicaid
PA460002936OtherRR MEDICARE PIN
PA460002936OtherRR MEDICARE
PACC9269OtherRR MEDICARE GROUP
NY00792810Medicaid
PAGU040055OtherPA MEDICARE GROUP
PAGU040055OtherPA MEDICARE GROUP
C28941Medicare UPIN
PA0009251070001Medicaid