Provider Demographics
NPI:1346233624
Name:JEAN, LEE GARDIE (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:GARDIE
Last Name:JEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2465
Mailing Address - Fax:717-741-3043
Practice Address - Street 1:5401 OLD COURT RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5103
Practice Address - Country:US
Practice Address - Phone:410-701-4502
Practice Address - Fax:410-521-7669
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424930207RC0200X, 207RP1001X
MDD56632207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101209096Medicaid
PA1671431OtherHIGHMARK BLUE SHIELD
PA20087292OtherAMERIHEALTH MERCY-WMG
PA271387OtherUNISON-WMG
MD614218OtherCAREFIRST MD BCBS
PA1542467OtherGATEWAY-WMG
PA085307Medicare PIN
MD614218OtherCAREFIRST MD BCBS
PAG31583Medicare UPIN
PA101209096Medicaid