Basic Information
Provider Information
NPI: 1508165796
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: PAUL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 636256
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452636256
CountryCode: US
TelephoneNumber: 5132453600
FaxNumber: 5132453672
Practice Location
Address1: 234 GOODMAN ST
Address2:  
City: CINCINNATI
State: OH
PostalCode: 45219
CountryCode: US
TelephoneNumber: 5135847284
FaxNumber: 5135843807
Other Information
ProviderEnumerationDate: 03/28/2011
LastUpdateDate: 07/09/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0102X35134190OHY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

No ID Information.


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