MEDICARE: DR. SAMMY LEE DPM

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	213EP1101X	Primary Podiatric Medicine Podiatrist	2170	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	408713	OTHER	MA	TUFTS HEALTH PLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	Y71090	OTHER	MA	BCBS MA

General Provider Information

NPI Number	:	1033191481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMMY LEE DPM

Provider Business Mailing Address
First Line	:	39 OLYMPIC VILLAGE DR
Second Line	:
City	:	METHUEN
State	:	MA
Zip	:	01844-4158
Country	:	US
Telephone Number	:	617-448-9541
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 SPRINGS RD
Second Line	:
City	:	BEDFORD
State	:	MA
Zip	:	01730-1198
Country	:	US
Telephone Number	:	781-687-4321
Fax Number	:

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	06/01/2022

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