Provider Demographics
NPI:1538182670
Name:LEE, KENNETH K (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 WARM SPRINGS AVENUE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652
Mailing Address - Country:US
Mailing Address - Phone:814-643-3808
Mailing Address - Fax:814-643-8272
Practice Address - Street 1:1227 WARM SPRINGS AVENUE
Practice Address - Street 2:SUITE 302
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652
Practice Address - Country:US
Practice Address - Phone:814-643-3808
Practice Address - Fax:814-643-8272
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006997210002Medicaid
E90119Medicare UPIN
165460Medicare ID - Type Unspecified