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NPI Code Detail

MEDICARE: DR. MICHAEL K LEA PHD, PSYD

MEDICARE: DR. MICHAEL K LEA PHD, PSYD
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
1101YP2500XProfessional CounselorLC0974MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1F453-0001OTHERCAREFIRST BLUECHOICE
2604856-02OTHERCAREFIRST BC/BS-MD

General Provider Information

NPI Number : 1215932678
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL K LEA PHD, PSYD
Provider Business Mailing Address
First Line : 6045 SOLOMONS ISLAND RD
Second Line :
City : HUNTINGTOWN
State : MD
Zip : 20639-8876
Country : US
Telephone Number : 410-257-5200
Fax Number : 410-257-2442
Provider Business Practice Location Address
First Line : 6045 SOLOMONS ISLAND RD
Second Line :
City : HUNTINGTOWN
State : MD
Zip : 20639-8876
Country : US
Telephone Number : 410-257-5200
Fax Number : 410-257-2442
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 07/08/2007

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