MEDICARE: DR. ALFRED 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	207RG0100X	Gastroenterology Physician	0101033290	VA

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

General Provider Information

NPI Number	:	1689675837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFRED LEE M.D.

Provider Business Mailing Address
First Line	:	107 WADSWORTH DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-4521
Country	:	US
Telephone Number	:	804-330-4901
Fax Number	:	804-330-9145

Provider Business Practice Location Address
First Line	:	16011 KAIROS RD
Second Line	:	STE 300
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23834-5207
Country	:	US
Telephone Number	:	804-520-5223
Fax Number	:

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	01/03/2019

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