Provider Demographics
NPI:1184809030
Name:LEE, GERALD K (MD, PHD)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:K
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:P.O. BOX 2041
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20108-0815
Mailing Address - Country:US
Mailing Address - Phone:703-361-4357
Mailing Address - Fax:703-361-0346
Practice Address - Street 1:8551 RIXLEW LANE
Practice Address - Street 2:SUITE 140
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4278
Practice Address - Country:US
Practice Address - Phone:703-361-4357
Practice Address - Fax:703-361-0346
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054211207RA0401X, 208D00000X
VA0101057543208D00000X, 207RA0401X
VA01010575543208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA182042OtherANTHEM
VA182042OtherANTHEM