MEDICARE: SONTAEK THEODORE LEE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	D0014522	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	D0014522	OTHER	MD	STATE LICENSE

General Provider Information

NPI Number	:	1053330894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONTAEK THEODORE LEE M.D.

Provider Business Mailing Address
First Line	:	11217 LOCKWOOD DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-4550
Country	:	US
Telephone Number	:	301-681-7712
Fax Number	:	301-681-7734

Provider Business Practice Location Address
First Line	:	11217 LOCKWOOD DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-4550
Country	:	US
Telephone Number	:	301-681-7712
Fax Number	:	301-681-7734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	03/07/2023

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