Healthcare Provider Details

I. General information

NPI: 1053330894
Provider Name (Legal Business Name): SONTAEK THEODORE LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11217 LOCKWOOD DR
SILVER SPRING MD
20901-4550
US

IV. Provider business mailing address

11217 LOCKWOOD DR
SILVER SPRING MD
20901-4550
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-7712
  • Fax: 301-681-7734
Mailing address:
  • Phone: 301-681-7712
  • Fax: 301-681-7734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD0014522
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: