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General NPI Number Information
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NPI Number | 1447683461
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Entity Type | Organization
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Legal Business Name | BENJAMIN LEE,MD
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 12/23/2015
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Provider Practice Location Address
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Address Line | 216 E PULASKI HWY SUITE120
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City | ELKTON
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State | MD
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Zip | 21921-6497
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Country | US
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Telephone | 443-490-4000
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Fax | 443-484-2831
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Provider Business Mailing Address
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Address Line | 2012 S.TOLLGATE RD SUITE 102
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City | BEL AIR
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State | MD
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Zip | 21015-5901
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Country | US
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Telephone | 443-490-4000
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Fax | 443-484-2831
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Authorized Official
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Title or Position | OWNER
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Name | DR. BENJAMIN LEE
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Credential | M.D.
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Telephone | 443-490-4042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | D0057974
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License Number State | MD
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