Healthcare Provider Details

I. General information

NPI: 1366998957
Provider Name (Legal Business Name): B LEE MD ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 S TOLLGATE RD SUITE 102
BEL AIR MD
21015-5900
US

IV. Provider business mailing address

PO BOX 404
BEL AIR MD
21014-0404
US

V. Phone/Fax

Practice location:
  • Phone: 443-490-4000
  • Fax:
Mailing address:
  • Phone: 443-490-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. BENJAMIN LEE
Title or Position: CEO
Credential: M.D.
Phone: 443-490-4000