MEDICARE: DR. JOHN EDWARD 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	207V00000X	Obstetrics & Gynecology Physician	0101028544	VA

General Provider Information

NPI Number	:	1659349660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN EDWARD LEE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 15127
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23328-5127
Country	:	US
Telephone Number	:	757-547-8108
Fax Number	:

Provider Business Practice Location Address
First Line	:	637 KINGSBOROUGH SQ
Second Line	:	SUITE C
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-4944
Country	:	US
Telephone Number	:	757-547-8108
Fax Number	:

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	11/07/2008

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