Healthcare Provider Details

I. General information

NPI: 1902268477
Provider Name (Legal Business Name): REBECCA LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PROFESSIONAL CT STE C
MARTINSBURG WV
25401-8803
US

IV. Provider business mailing address

2000 PROFESSIONAL CT STE C
MARTINSBURG WV
25401-8803
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-8853
  • Fax: 304-263-6178
Mailing address:
  • Phone: 304-263-8853
  • Fax: 304-263-6178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28864
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101274758
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: