MEDICARE: MENG-CHAO LEE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	OS012030	PA
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	OS012030	PA

General Provider Information

NPI Number	:	1003836768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MENG-CHAO LEE D.O.

Provider Business Mailing Address
First Line	:	2450 W HUNTING PARK AVE
Second Line	:	2ND TPI
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1302
Country	:	US
Telephone Number	:	215-926-9010
Fax Number	:	215-226-8285

Provider Business Practice Location Address
First Line	:	7500 CENTRAL AVE STE 104
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2431
Country	:	US
Telephone Number	:	215-742-0712
Fax Number	:	215-742-5218

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	05/14/2021

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Directions to “ MENG-CHAO LEE D.O.” Practice Location

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