Provider Demographics
NPI:1073849824
Name:LEE NEUROSURGERY PC
Entity Type:Organization
Organization Name:LEE NEUROSURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BOTHWELL
Authorized Official - Middle Name:GRAVES
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-780-7908
Mailing Address - Street 1:8101 HINSON FARM ROAD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3404
Mailing Address - Country:US
Mailing Address - Phone:703-780-7908
Mailing Address - Fax:703-799-2118
Practice Address - Street 1:8101 HINSON FARM RD
Practice Address - Street 2:SUITE 112
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3403
Practice Address - Country:US
Practice Address - Phone:703-780-7908
Practice Address - Fax:703-799-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101221427207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
140000183Medicare PIN
490689Medicare PIN
B76461Medicare UPIN