Provider Demographics
NPI:1801056296
Name:LEE, THERESA MARGUERITE (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARGUERITE
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 TECHNOLOGY PKWY
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9422
Mailing Address - Country:US
Mailing Address - Phone:717-724-6780
Mailing Address - Fax:717-724-6781
Practice Address - Street 1:2035 TECHNOLOGY PKWY
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9422
Practice Address - Country:US
Practice Address - Phone:717-724-6780
Practice Address - Fax:717-724-6781
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451512207RX0202X, 207R00000X, 207RX0202X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102921262Medicaid
PA360327Medicare PIN