Lee Everett Edstrom, M.D.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

5949 Issued in RI

Practice address

2 Dudley
Suite 460
Providence, RI 02905

Phone

(401) 331-2303

Fax

(401) 331-4430

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1669566303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 DUDLEY",
            "address_2": "SUITE 460",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02905",
            "telephone_number": "401-331-2303",
            "fax_number": "401-331-4430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 DUDLEY",
            "address_2": "SUITE 460",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02905",
            "telephone_number": "401-331-2303",
            "fax_number": "401-331-4430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDSTROM",
        "first_name": "LEE",
        "middle_name": "EVERETT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "RI",
            "license": "5949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH",
            "identifier": "1300121",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECHIP",
            "identifier": "300043",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "050395339",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn B Eden, MSW LICSW
• Robert Emanuel Eden, M.D.
• Emily Jean Edgington, BCBA, LABA
• David A Edmonson, M.D.
• Liz Neidi Edmund, M.D.
• Edward a. Pensa Medical Inc.
• Edward Pensa, MD, LLC
• Jessica B. Edwards George, PH.D.
• Amber Lee Edwards
• Andrea Edwards

• Plastic Surgery Physician in Providence, RI
• Providers in Providence, RI by specialty
• Plastic Surgery Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.