Healthcare Provider Details

I. General information

NPI: 1043214810
Provider Name (Legal Business Name): JAMES PAUL LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11717 OLD NATIONAL PIKE #8
NEW MARKET MD
21774
US

IV. Provider business mailing address

11717 OLD NATIONAL PIKE #8
NEW MARKET MD
21774
US

V. Phone/Fax

Practice location:
  • Phone: 301-363-4663
  • Fax: 301-829-5820
Mailing address:
  • Phone: 301-363-4663
  • Fax: 301-829-5820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0033531
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberD0033531
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: