Provider Demographics
NPI:1053612614
Name:LEE, KRISTOFFERSON MONDINA (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTOFFERSON
Middle Name:MONDINA
Last Name:LEE
Suffix:
Gender:M
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:LAHEY CLINIC INC.
Mailing Address - Street 2:85 HERRICK STREET
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-922-3000
Mailing Address - Fax:
Practice Address - Street 1:819 WORCESTER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01151-1045
Practice Address - Country:US
Practice Address - Phone:413-543-6820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA246884207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine