Provider Demographics
NPI:1699891531
Name:LEE, LAUREN COSETTI
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:COSETTI
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:COSETTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6040 PUBLIC LANDING ROAD
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863-2453
Mailing Address - Country:US
Mailing Address - Phone:410-632-1100
Mailing Address - Fax:410-632-5682
Practice Address - Street 1:9730 HEALTHWAY DRIVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1154
Practice Address - Country:US
Practice Address - Phone:410-629-0164
Practice Address - Fax:410-629-0185
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD705371101Medicaid
MDS013Medicare ID - Type Unspecified