Individual
LEE ALLEN MADELINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1210 W FARIS RD, GREENVILLE, SC 29605-4444
(864) 295-4410
(864) 269-1386
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
20075
SC
2085R0202X
Diagnostic Radiology Physician
20075
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200758
—
SC
01
—
P00821918
RAILROAD MEDICARE
SC
Enumeration date
01/31/2006
Last updated
12/07/2022
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