MEDICARE: JONGWON 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	2085R0202X	Diagnostic Radiology Physician	MD061217L	PA
2	2085B0100X	Body Imaging Physician	MD061217L	PA
3	2085N0904X	Nuclear Radiology Physician	MD061217L	PA
4	2085P0229X	Pediatric Radiology Physician	MD061217L	PA
5	2085R0204X	Vascular & Interventional Radiology Physician	MD061217L	PA
6	2085U0001X	Diagnostic Ultrasound Physician	MD061217L	PA

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	277941	OTHER	PA	HIGHMARK

General Provider Information

NPI Number	:	1477512465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONGWON LEE MD

Provider Business Mailing Address
First Line	:	7 ACEE DR
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-9700
Country	:	US
Telephone Number	:	800-223-5544
Fax Number	:	724-294-3206

Provider Business Practice Location Address
First Line	:	835 HOSPITAL RD
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-3629
Country	:	US
Telephone Number	:	724-357-7125
Fax Number	:	724-357-7482

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	11/27/2007

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