Lee, Shane

Lee, Shane is an individual health care provider with primary practice located at 3401 N Broad St , Philadelphia PA 19140. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology is his primary health care specialty. Lee, Shane can be contacted via phone (215) 707-7237.

Contact Information

Primary practice address
3401 N Broad St Philadelphia PA 19140
Phone: (215) 707-7237
Fax: (215) 707-9389
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 203BR0202X Pennsylvania
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X MD449493 Pennsylvania

Profile Details

NPI number 1104067651
LBN Legal business name Lee, Shane
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 12th, 2009
Last updated Sep 11th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104067651 NPPES
New Jersey MEDICAID 0383686
New Jersey MEDICAID 102844548

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