Healthcare Provider Details

I. General information

NPI: 1841244126
Provider Name (Legal Business Name): J. T. LEE, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 REVOLUTION ST
HAVRE DE GRACE MD
21078-3319
US

IV. Provider business mailing address

669 REVOLUTION ST
HAVRE DE GRACE MD
21078-3319
US

V. Phone/Fax

Practice location:
  • Phone: 410-939-2840
  • Fax: 410-939-2329
Mailing address:
  • Phone: 410-939-2840
  • Fax: 410-939-2329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0020661
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberD0020661
License Number StateMD

VIII. Authorized Official

Name: DR. JEAN T LEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-939-2840