Provider Demographics
NPI:1780698308
Name:LEE, KEVIN K (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1227 WARM SPRINGS AVENUE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652
Mailing Address - Country:US
Mailing Address - Phone:814-643-4663
Mailing Address - Fax:814-643-9273
Practice Address - Street 1:1227 WARM SPRINGS AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-2300
Practice Address - Country:US
Practice Address - Phone:814-643-4663
Practice Address - Fax:814-643-9273
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD036933L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0826145Medicaid
PAF02483Medicare UPIN
PA127508KU1Medicare PIN