Individual
JASON O LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
836 FARMINGTON AVENUE, SUITE 207, WEST HARTFORD, CT 06119
(860) 232-9911
(860) 233-5996
Mailing address
836 FARMINGTON AVENUE, SUITE 207, WEST HARTFORD, CT 06119
(860) 232-9911
(860) 233-5996
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
038654
CT
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
038654
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001386540
—
CT
05
—
00138654000
—
CT
01
—
004394508
MEDICAID GROUP CAAC
—
01
—
010038654CT01
BLUE CROSS
—
01
—
038654
CONNECTICARE
—
01
—
043518
AETNA
—
01
—
1179424002
CIGNA
—
01
—
224829
PREFERRED ONE
—
05
—
OV7942
—
CT
01
—
P2666151
OXFORD
—
Enumeration date
11/09/2005
Last updated
04/14/2022
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