MEDICARE: ALVIN LEE SR.

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	171W00000X	Contractor	2701032766	VA

General Provider Information

NPI Number	:	1619220464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALVIN LEE SR.

Provider Business Mailing Address
First Line	:	1713 SOUTH ST
Second Line	:
City	:	FRANKLIN
State	:	VA
Zip	:	23851-2546
Country	:	US
Telephone Number	:	757-651-9539
Fax Number	:

Provider Business Practice Location Address
First Line	:	1713 SOUTH ST
Second Line	:
City	:	FRANKLIN
State	:	VA
Zip	:	23851-2546
Country	:	US
Telephone Number	:	757-651-9539
Fax Number	:

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

Provider Enumeration Date	:	10/17/2012
Last Update Date	:	11/29/2012

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