Provider Demographics
NPI:1003874025
Name:LEE, SOPHIA D (MD)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:D
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:224-D CORNWALL ST NW
Mailing Address - Street 2:SUITE 403
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1816
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:8988 LORTON STATION BLVD, SUITE 202
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4758
Practice Address - Country:US
Practice Address - Phone:703-372-2280
Practice Address - Fax:703-372-2024
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101102658208600000X
MI4301087204208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06115OtherGROUP PTAN
VAC06695OtherGROUP PTAN
VA30015941430001Medicaid