MEDICARE: DR. LEE MARY EDWARDS DO

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	260992	NY

General Provider Information

NPI Number	:	1922279553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE MARY EDWARDS DO

Provider Business Mailing Address
First Line	:	485 TITUS AVE
Second Line	:	SUITE F
City	:	ROCHESTER
State	:	NY
Zip	:	14617-3535
Country	:	US
Telephone Number	:	585-266-0310
Fax Number	:	585-266-9207

Provider Business Practice Location Address
First Line	:	485 TITUS AVE
Second Line	:	SUITE F
City	:	ROCHESTER
State	:	NY
Zip	:	14617-3535
Country	:	US
Telephone Number	:	585-266-0310
Fax Number	:	585-266-9207

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

Provider Enumeration Date	:	03/24/2008
Last Update Date	:	02/12/2014

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