Healthcare Provider Details

I. General information

NPI: 1194723163
Provider Name (Legal Business Name): LEE DICKINSON ROWE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

2340 E ALLEGHENY AVE
PHILA PA
19134-4433
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE
PHILA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-423-6670
  • Fax: 215-423-7787
Mailing address:
  • Phone: 215-926-9022
  • Fax: 215-226-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMD017012E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: