Provider Demographics
NPI:1093822421
Name:SURKIN, LEE A (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:A
Last Name:SURKIN
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 1:2459 EMERALD PL STE 102
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5739
Mailing Address - Country:US
Mailing Address - Phone:252-757-3939
Mailing Address - Fax:252-757-3973
Practice Address - Street 1:2459 EMERALD PL STE 102
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5739
Practice Address - Country:US
Practice Address - Phone:252-757-3939
Practice Address - Fax:252-757-3973
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246452207RC0000X
NC9700775207RS0012X, 207RC0000X
NY284359207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910551Medicaid
NC8910551Medicaid
NCG52523Medicare UPIN