MEDICARE: DR. DAVID FOWLER TEE M. D.

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	207R00000X	Internal Medicine Physician	38628	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	B27151	OTHER	MA	BCBS OF MA.
3	706181	OTHER	MA	TUFTS

General Provider Information

NPI Number	:	1003884677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID FOWLER TEE M. D.

Provider Business Mailing Address
First Line	:	380 PLEASANT ST
Second Line	:	SUITE 1-1
City	:	MALDEN
State	:	MA
Zip	:	02148-8123
Country	:	US
Telephone Number	:	781-324-9100
Fax Number	:	781-397-1345

Provider Business Practice Location Address
First Line	:	380 PLEASANT ST
Second Line	:	SUITE 1-1
City	:	MALDEN
State	:	MA
Zip	:	02148-8123
Country	:	US
Telephone Number	:	781-324-9100
Fax Number	:	781-397-1345

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	07/08/2007

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