Healthcare Provider Details

I. General information

NPI: 1497783393
Provider Name (Legal Business Name): LEE A KLEIMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 JUMPERS HOLE RD SUITE 304
SEVERNA PARK MD
21146-1600
US

IV. Provider business mailing address

600 RIDGELY AVE STE 110
ANNAPOLIS MD
21401-1082
US

V. Phone/Fax

Practice location:
  • Phone: 410-573-9191
  • Fax: 410-573-5910
Mailing address:
  • Phone: 410-573-9191
  • Fax: 410-573-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0041107
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD0041107
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberD0041107
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberD0041107
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: