Provider Demographics
NPI:1902964455
Name:F A MCGOWAN & R D LEE
Entity Type:Organization
Organization Name:F A MCGOWAN & R D LEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:610-586-1919
Mailing Address - Street 1:115 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19023-3809
Mailing Address - Country:US
Mailing Address - Phone:610-586-1919
Mailing Address - Fax:610-586-6947
Practice Address - Street 1:115 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:COLLINGDALE
Practice Address - State:PA
Practice Address - Zip Code:19023-3809
Practice Address - Country:US
Practice Address - Phone:610-586-1919
Practice Address - Fax:610-586-6947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006159-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0307511001OtherINDEPENDENCE BLUE CROSS
PAD 19240OtherINTER-COUNTY HEALTH HOS
PA098616OtherAETNA U S HEALTHCARE
PA1141676Medicaid
PAD98739Medicare UPIN
PA098616OtherAETNA U S HEALTHCARE