Provider Demographics
NPI:1174726723
Name:JOHN J. LEE, MD, PC
Entity type:Organization
Organization Name:JOHN J. LEE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-622-6004
Mailing Address - Street 1:142 W YORK ST
Mailing Address - Street 2:SUITE 708
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2015
Mailing Address - Country:US
Mailing Address - Phone:757-622-6004
Mailing Address - Fax:757-622-6005
Practice Address - Street 1:142 W YORK ST
Practice Address - Street 2:SUITE 708
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2015
Practice Address - Country:US
Practice Address - Phone:757-622-6004
Practice Address - Fax:757-622-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022064174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD38100Medicare UPIN