Provider Demographics
NPI:1811991573
Name:LEE, LORI A (DO)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ABBOTT ROAD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-1114
Mailing Address - Country:US
Mailing Address - Phone:716-826-6628
Mailing Address - Fax:716-828-3448
Practice Address - Street 1:565 ABBOTT ROAD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-1114
Practice Address - Country:US
Practice Address - Phone:716-826-6628
Practice Address - Fax:716-828-3448
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005596363AS0400X
390200000X
NY274260207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01792474Medicaid
NY01792474Medicaid
NYS06314Medicare UPIN