Basic Information
Provider Information
NPI: 1982641577
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: BETTY
MiddleName: S
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5525 RESEARCH PARK DR
Address2: 4TH FLOOR
City: BALTIMORE
State: MD
PostalCode: 212284873
CountryCode: US
TelephoneNumber: 7815347100
FaxNumber: 7815347358
Practice Location
Address1: 300 LINDEN PONDS WAY
Address2:  
City: HINGHAM
State: MA
PostalCode: 020433791
CountryCode: US
TelephoneNumber: 7815347100
FaxNumber: 7815347358
Other Information
ProviderEnumerationDate: 06/01/2006
LastUpdateDate: 05/03/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X221313MAN Allopathic & Osteopathic PhysiciansHospitalist 
207R00000X221313MAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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