Healthcare Provider Details

I. General information

NPI: 1033573373
Provider Name (Legal Business Name): PEI-SHAN LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

110 S PACA ST FL 8
BALTIMORE MD
21201-1644
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6003
  • Fax:
Mailing address:
  • Phone: 410-328-6003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA151066
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0092810
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: