Provider Demographics
NPI:1073724712
Name:LEE, PATRICIA W (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:W
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 SAMARITAN DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3912
Mailing Address - Country:US
Mailing Address - Phone:408-358-1855
Mailing Address - Fax:408-356-4183
Practice Address - Street 1:2450 SAMARITAN DR
Practice Address - Street 2:#1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3912
Practice Address - Country:US
Practice Address - Phone:408-358-1855
Practice Address - Fax:408-356-4183
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD33189208600000X
WA61138838208600000X
MDD00666312086S0102X
CAA102563208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC19460039OtherCARFISRT BCBS
CAAY109ZOtherMEDICARE PTAN
MD413363301Medicaid
MD61543001OtherCAREFIRST BCBS