Provider Demographics
NPI:1770596942
Name:LEE, SARA JANE (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JANE
Other - Last Name:ALBERTELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4 CENTENNIAL DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7935
Mailing Address - Country:US
Mailing Address - Phone:978-977-0351
Mailing Address - Fax:978-977-0905
Practice Address - Street 1:4 CENTENNIAL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7935
Practice Address - Country:US
Practice Address - Phone:978-977-0351
Practice Address - Fax:978-977-0905
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150809208100000X
NH10278208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3177025Medicaid
A23786Medicare ID - Type Unspecified
G69538Medicare UPIN