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General NPI Number Information
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NPI Number | 1457742405
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Entity Type | Individual
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Provider Name | BRITTANI LEE
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Gender | Female
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 1245 EASTERN BLVD
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City | BALTIMORE
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State | MD
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Zip | 21221-3422
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Country | US
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Telephone | 410-558-4700
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Fax | 410-780-0364
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Provider Business Mailing Address
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Address Line | 3501 SINCLAIR LN
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City | BALTIMORE
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State | MD
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Zip | 21213-2029
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Country | US
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Telephone | 410-732-8800
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Fax | 443-703-3242
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9108540
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License Number State | ZZ
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | PA9108540
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C06008
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License Number State | MD
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