Provider Demographics
NPI:1013183243
Name:LEE, PATRICK L (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:L
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11437 DAIRY ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2662
Mailing Address - Country:US
Mailing Address - Phone:410-988-4443
Mailing Address - Fax:
Practice Address - Street 1:11437 DAIRY ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2662
Practice Address - Country:US
Practice Address - Phone:410-988-4443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0068714207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417085700Medicaid
MDD0068714OtherMARYLAND LICENSE
MD162110ZACHMedicare PIN