Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 0401008317 | VA |
N | 213EG0000X | General Practice | 0401008317 | VA |
Y | 1223G0001X | General Practice | 8517 | MD |
Y | 213EG0000X | General Practice | 8517 | MD |
N | 1223G0001X | General Practice | DEN4236 | DC |
N | 213EG0000X | General Practice | DEN4236 | DC |
NPI | 1003038928 |
---|---|
Provider Name | Fred Matthew Lee |
First Address | Bethesda, MD 20817-2219 |
Second Address | Baltimore, MD 21201-1510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 05/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016891200 | (05) | DC |
U07503 | (02) |