Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 0101102658 | VA |
Y | 208600000X | Surgeon | 0101102658 | VA |
N | 208200000X | Surgeon | 4301087204 | MI |
N | 208600000X | Surgeon | 4301087204 | MI |
NPI | 1003874025 |
---|---|
Provider Name | Dr. Sophia D Lee |
First Address | Mechanicsville, VA 23116-1816 |
Second Address | Mechanicsville, VA 23116-1816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 09/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C06115 | GROUP PTAN (01) | VA |
C06695 | GROUP PTAN (01) | VA |