Provider Demographics
NPI:1194723163
Name:ROWE, LEE DICKINSON (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:DICKINSON
Last Name:ROWE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-926-9022
Mailing Address - Fax:215-226-8286
Practice Address - Street 1:2340 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19134-4433
Practice Address - Country:US
Practice Address - Phone:215-423-6670
Practice Address - Fax:215-423-7787
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2016-12-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
PAMD017012E207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000813272Medicaid
PA000813272Medicaid
PAA47078Medicare UPIN