Healthcare Provider Details

I. General information

NPI: 1760976807
Provider Name (Legal Business Name): CHELSEA LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

3330 WOODBURN VILLAGE DR APT 23
ANNANDALE VA
22003-6870
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-6652
  • Fax:
Mailing address:
  • Phone: 443-812-0237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116032054
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: