MEDICARE: DR. JANICE L LEE MD

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	207VG0400X	Gynecology Physician	020580	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	163223	OTHER	CT	FRIST CHOICE
2	P751454	OTHER	CT	OXFOTORD

General Provider Information

NPI Number	:	1417912791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANICE L LEE MD

Provider Business Mailing Address
First Line	:	1 MAIN ST
Second Line	:	HARTFORD GYN CENTER
City	:	HARTFORD
State	:	CT
Zip	:	06106-1806
Country	:	US
Telephone Number	:	806-525-1900
Fax Number	:	856-414-1660

Provider Business Practice Location Address
First Line	:	1 MAIN ST
Second Line	:	HARTFORD GYN CENTER
City	:	HARTFORD
State	:	CT
Zip	:	06106-1806
Country	:	US
Telephone Number	:	806-525-1900
Fax Number	:	856-414-1660

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2007

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