MEDICARE: DR. STGEORGE TUCKER 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	207RC0000X	Cardiovascular Disease Physician	010121941	VA

General Provider Information

NPI Number	:	1942636014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STGEORGE TUCKER LEE M.D.

Provider Business Mailing Address
First Line	:	718 J CLYDE MORRIS BLVD
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1540
Country	:	US
Telephone Number	:	757-593-2363
Fax Number	:	757-873-8566

Provider Business Practice Location Address
First Line	:	718 J CLYDE MORRIS BLVD
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1540
Country	:	US
Telephone Number	:	757-593-2363
Fax Number	:	757-873-8566

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

Provider Enumeration Date	:	09/20/2013
Last Update Date	:	09/20/2013

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