Provider Demographics
NPI:1093794067
Name:LEE, DAVID W (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 791128
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-1128
Mailing Address - Country:US
Mailing Address - Phone:703-391-2030
Mailing Address - Fax:703-273-3943
Practice Address - Street 1:8988 LORTON STATION BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4756
Practice Address - Country:US
Practice Address - Phone:703-339-7550
Practice Address - Fax:703-339-7553
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010061031Medicaid
VA179656OtherANTHEM
VA010061031Medicaid
DEG00532Medicare PIN
DCG00532Medicare PIN
MDG00532Medicare PIN
VAG01950G01Medicare PIN
VA011200F32Medicare PIN