Provider Demographics
NPI:1043285190
Name:LEE, EDWARD JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JAMES
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10710 CHARTER DR
Mailing Address - Street 2:SUITE G020
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3128
Mailing Address - Country:US
Mailing Address - Phone:410-964-2212
Mailing Address - Fax:410-964-0380
Practice Address - Street 1:10710 CHARTER DR
Practice Address - Street 2:SUITE G020
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3128
Practice Address - Country:US
Practice Address - Phone:410-964-2212
Practice Address - Fax:410-964-0380
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0023601207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD156621100Medicaid
E10893Medicare UPIN
498M754FMedicare ID - Type Unspecified