Basic Information
| Provider Information | |||||||||
| NPI: | 1336164839 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE-POWELL | ||||||||
| FirstName: | ROBERTA | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 MARKET STREET | ||||||||
| Address2: | LM 500 WEST TOWER | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191202100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159852595 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1200 CALLOWHILL ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191233658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158258220 | ||||||||
| FaxNumber: | 2158258254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS005603L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0104270003 | 01 | PA | AMERICHOICE | OTHER | 001042730001 | 05 | PA | MEDICAID | 1010001 | 01 | PA | KEYSTONE MERCY | OTHER | 19749 | 01 | PA | AETNA | OTHER | 02895OS005603L | 01 | PA | HEALTH PARTNERS | OTHER | 0058413000 | 01 | PA | KEYSTONE HEALTH PLAN EAST | OTHER |