Healthcare Provider Details

I. General information

NPI: 1578723698
Provider Name (Legal Business Name): MARY E LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY JEON

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10903 NEW HAMPSHIRE AVE BUILDING 75, ROOM 2521
SILVER SPRING MD
20993-4908
US

IV. Provider business mailing address

10903 NEW HAMPSHIRE AVE BUILDING 75, ROOM 2521
SILVER SPRING MD
20993-4908
US

V. Phone/Fax

Practice location:
  • Phone: 301-796-0214
  • Fax:
Mailing address:
  • Phone: 301-796-0214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD038660
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101249628
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number0101249628
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: