Provider Demographics
NPI:1194919530
Name:DAVID F TEE MD PC
Entity type:Organization
Organization Name:DAVID F TEE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FOWLER
Authorized Official - Last Name:TEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-324-9100
Mailing Address - Street 1:380 PLEASANT ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148
Mailing Address - Country:US
Mailing Address - Phone:781-324-9100
Mailing Address - Fax:781-397-1345
Practice Address - Street 1:380 PLEASANT ST
Practice Address - Street 2:STE 11
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02149
Practice Address - Country:US
Practice Address - Phone:781-324-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38628MA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2051737Medicaid
MA2051737Medicaid