Healthcare Provider Details

I. General information

NPI: 1376803361
Provider Name (Legal Business Name): ANGELICA MARIA LEE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4954 N PALMER RD DEPT OF
BETHESDA MD
20889-2422
US

IV. Provider business mailing address

4301 JONES BRIDGE RD
BETHESDA MD
20814-4712
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4771
  • Fax: 301-295-4759
Mailing address:
  • Phone: 301-295-9683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberH0087479
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberH0087479
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: