| Jonathan M Lee Llc | |
|
200 Providence Hwy Suite 202-203 Dedham MA 02026-1881 | |
| (781) 326-1464 | |
| (781) 326-9075 |
| Full Name | Jonathan M Lee Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 200 Providence Hwy, Dedham, Massachusetts |
| Authorized Official Name and Position | Jonathan Mark Lee (INTERNIST) |
| Authorized Official Contact | 7813261464 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jonathan M Lee Llc 200 Providence Hwy Suite 202-203 Dedham MA 02026-1881 Ph: (781) 326-1464 | Jonathan M Lee Llc 200 Providence Hwy Suite 202-203 Dedham MA 02026-1881 Ph: (781) 326-1464 |
| NPI Number | 1023312584 |
|---|---|
| Provider Enumeration Date | 12/27/2010 |
| Last Update Date | 04/08/2011 |
| Medicare PECOS PAC ID | 6204000813 |
|---|---|
| Medicare Enrollment ID | O20111116000847 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023312584 | NPI | - | NPPES |
| 3062601 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 72678 (Massachusetts) | Primary |
| Provider Name | Jonathan M Lee |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003917626 PECOS PAC ID: 0345297735 Enrollment ID: I20050407000621 |
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