Healthcare Provider Details

I. General information

NPI: 1740249408
Provider Name (Legal Business Name): THOMAS DAE LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 08/02/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 LANDMARK DR. STE 119
GLEN BURNIE MD
21061
US

IV. Provider business mailing address

802 LANDMARK DR STE 119
GLEN BURNIE MD
21061
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-8840
  • Fax: 410-367-2464
Mailing address:
  • Phone: 410-760-8840
  • Fax: 410-760-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD0065705
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: