Provider Demographics
NPI:1003947243
Name:LINDA A LEE, MD, PC
Entity Type:Organization
Organization Name:LINDA A LEE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-321-1082
Mailing Address - Street 1:658 KENILWORTH DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2312
Mailing Address - Country:US
Mailing Address - Phone:410-321-1082
Mailing Address - Fax:
Practice Address - Street 1:658 KENILWORTH DR
Practice Address - Street 2:SUITE 206
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2312
Practice Address - Country:US
Practice Address - Phone:410-321-1082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041772207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1639155294OtherPROVIDER NPI
MD167NMedicare ID - Type Unspecified
MD1639155294OtherPROVIDER NPI