Basic Information
| Provider Information | |||||||||
| NPI: | 1851654172 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 COTTMAN AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191112497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157283883 | ||||||||
| FaxNumber: | 2157281185 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 COTTMAN AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191112434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157286900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2012 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 1073 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 208D00000X | 1073 | NE | N | Allopathic & Osteopathic Physicians | General Practice | 2085R0001X | OS019478 | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.