MR. MATTHEW KERMIT LEE (NPI# 1770932220) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1770932220 |
Entity Type | Individual |
Full Name | MR. MATTHEW KERMIT LEE |
Credential | IDC |
Practice Address |
465 Trout Ave Numi Groton CT 06340 |
Practice Telephone | 6806666666 |
Enumeration Date | 2016-06-06 |
Last Update Date | 2016-06-06 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1730738576 | Matthew Wesley Lee | Physical Therapist | 7111 Medical Center Dr Ste 111, Texas City, TX 77591-2667 | 2019-09-04 |
1265958847 | Matthew Lee | Specialist/Technologist | 950 Blaine St, Los Angeles, CA 90015-1220 | 2017-08-16 |
1093254369 | Matthew Lee | Chiropractor | 14000 Park Center Rd, Herndon, VA 20171-3227 | 2017-02-19 |
1326595612 | Matthew C. Lee | Counselor | 4 Summer Ln, Marlborough, CT 06447-1462 | 2016-09-05 |
1255793568 | Matthew Lee | Student in an Organized Health Care Education/Training Program | 14106 Manderson Plz, 204, Omaha, NE 68164-6288 | 2016-03-25 |
1023421435 | Matthew Lee | Dentist | 2525 W 16th St Ste A, Greeley, CO 80634-4951 | 2014-06-04 |
1780893917 | Matthew C Lee | Pharmacist | 1617 Monument Ave Ste 302, Richmond, VA 23220-2943 | 2007-05-22 |
1356408470 | Matthew Jonghyock Lee | Dentist | 306 Broad Ave Suite 2c, Palisades Park, NJ 07650 | 2007-01-02 |
1649359613 | Matthew J Lee | Physical Therapist | 102 Williams Rd, Nicholasville, KY 40356-1917 | 2006-11-02 |
1710915996 | Matthew D Lee | Physician Assistant | 9 Richland Medical Park, Suite 505, Columbia, SC 29203-6844 | 2006-06-28 |
Street Address |
465 TROUT AVE NUMI |
City | GROTON |
State | CT |
Zip Code | 06340 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912558610 | Bruce Lancel Bernardo Lara | Military Health Care Provider | Fpo, Ae, 09587-2417, Groton, AE 06340 | 2019-09-24 |
1295393692 | Ermelinda Elaine Alviso | Military Health Care Provider | Trout Ave, Groton, CT 06340 | 2019-05-31 |
1679034011 | Derek James Hale | Military Health Care Provider | Fc 83 Numi, Trout Ave, Groton, CT 06340 | 2019-03-28 |
1063973790 | Cody Eugene Shaw | Military Health Care Provider | Numi, Trout Ave Building 83, Groton, CT 06340 | 2019-03-26 |
1265906911 | Homelife Companions and Homemakers, LLC | Adult Companion | 1 Fort Hill Road, Suite 3, Groton, CT 06340 | 2019-01-16 |
1144735457 | Kristina Marie Carta | Behavior Technician | 220 Rt 12, Suite 205, Groton, CT 06340 | 2017-12-08 |
1538674262 | Tercel Dental Pllc | Dentist | 643 Gold Star Hwy., Groton, CT 06340 | 2017-12-04 |
1306361662 | Stonington Behavioral Health Inc | Psychologist | 618 Poquonnock Rd, Groton, CT 06340 | 2017-08-08 |
1104347806 | Renae Reynolds | Optometrist | 489 Gold Star Hwy Ste 100, Groton, CT 06340 | 2017-07-03 |
1053831552 | Susan A Bradbury | Physical Therapist | 455 Eastern Point Rd, Groton, CT 06340 | 2017-06-26 |
Find all providers in zip 06340 |
Taxonomy Code | 1710I1002X |
Grouping | Other Service Providers |
Classification | Military Health Care Provider |
Specialization | Independent Duty Corpsman |
A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1063052819 | Kenny Daniel Harp | Military Health Care Provider | 59 Deerwood Dr, Groton, CT 06340-2513 | 2020-01-09 |
1982244737 | Lonnie Jay Reardon | Military Health Care Provider | 55 South Rd Apt 12c, Groton, CT 06340-4660 | 2020-01-09 |
1376194274 | Christopher Lee Roy Smith | Military Health Care Provider | Uss San Juan (ssn 751), Groton, CT 06349 | 2019-09-23 |
1679132112 | Hector Salvador Gonzalez | Military Health Care Provider | 2 Bushnell St, Groton, CT 06340-3306 | 2019-06-09 |
1295393692 | Ermelinda Elaine Alviso | Military Health Care Provider | Trout Ave, Groton, CT 06340 | 2019-05-31 |
1558929026 | Joshua Darren Savage | Military Health Care Provider | 35 Chrissos St, Groton, CT 06340-3307 | 2019-05-30 |
1679034011 | Derek James Hale | Military Health Care Provider | Fc 83 Numi, Trout Ave, Groton, CT 06340 | 2019-03-28 |
1063973790 | Cody Eugene Shaw | Military Health Care Provider | Numi, Trout Ave Building 83, Groton, CT 06340 | 2019-03-26 |
1689179640 | David Saunders | Military Health Care Provider | 159 Navsubase Nlon, Groton, CT 06349 | 2018-03-29 |
1992241228 | Phillip Lawernce Hardy Sr. | Military Health Care Provider | 123 Trout Ave, Naval Undersea Medical Institiute, Groton, CT 06340-5159 | 2017-01-10 |
Find all providers in GROTON |
Please comment or provide details below to improve the information on MR. MATTHEW KERMIT LEE.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.