Provider Demographics
NPI:1770559213
Name:BESEN, LEE T (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:T
Last Name:BESEN
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 1:1339 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2055
Mailing Address - Country:US
Mailing Address - Phone:570-383-2435
Mailing Address - Fax:570-383-9048
Practice Address - Street 1:1339 MAIN ST
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2055
Practice Address - Country:US
Practice Address - Phone:570-383-2435
Practice Address - Fax:570-383-2435
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023945E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009345900001Medicaid
PAB34064Medicare UPIN
PA038278Medicare PIN