Provider Demographics
NPI:1811973472
Name:LEE, JOHN J (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:LEE
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 1:2050 W CHESTER PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2742
Mailing Address - Country:US
Mailing Address - Phone:610-789-6701
Mailing Address - Fax:610-789-6704
Practice Address - Street 1:2050 W CHESTER PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2742
Practice Address - Country:US
Practice Address - Phone:610-789-6701
Practice Address - Fax:610-789-6704
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071940L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA053512T23OtherRAILROAD MEDICARE
PA053512T23Medicare PIN
PA053512T23OtherRAILROAD MEDICARE