Healthcare Provider Details

I. General information

NPI: 1902097074
Provider Name (Legal Business Name): RICHARD G. LEE, DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2843 DUKE ST
ALEXANDRIA VA
22314-4512
US

IV. Provider business mailing address

2843 DUKE ST
ALEXANDRIA VA
22314-4512
US

V. Phone/Fax

Practice location:
  • Phone: 703-823-2357
  • Fax: 703-823-1572
Mailing address:
  • Phone: 703-823-2357
  • Fax: 703-823-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103001022
License Number StateVA

VIII. Authorized Official

Name: DR. RICHARD G. LEE
Title or Position: PRESIDENT
Credential: DPM
Phone: 703-823-2357