Provider Demographics
NPI:1063516326
Name:CORWIN, LEE I (MD PC)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:I
Last Name:CORWIN
Suffix:
Gender:M
Credentials:MD PC
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Mailing Address - Street 1:45 RESNIK RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360
Mailing Address - Country:US
Mailing Address - Phone:508-746-9040
Mailing Address - Fax:508-746-9041
Practice Address - Street 1:45 RESNIK RD
Practice Address - Street 2:SUITE 207
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:508-746-9040
Practice Address - Fax:508-746-9041
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA480232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0500656OtherUNITED HEALTHCARE
MA130025969OtherRR MEDICARE
MA705224OtherTUFTS
MA111189OtherHPHC
MA2790297OtherAETNA
MA9722581Medicaid
MAC15094OtherBCBS
MAC15094OtherBCBS
MA2790297OtherAETNA