Provider Demographics
NPI:1801058417
Name:LEE, COURTNEY (MD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
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 1:5201 HAVERFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-1401
Mailing Address - Country:US
Mailing Address - Phone:215-471-2761
Mailing Address - Fax:215-472-6092
Practice Address - Street 1:5201 HAVERFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-1401
Practice Address - Country:US
Practice Address - Phone:215-471-2761
Practice Address - Fax:215-472-6092
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT193885207Q00000X
MO2013012533207Q00000X
PAMD442860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine