Provider Demographics
NPI:1104856970
Name:LEE, ELAINA L (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINA
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1413 CARPENTER FLETCHER RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2007
Mailing Address - Country:US
Mailing Address - Phone:919-544-6461
Mailing Address - Fax:919-361-2487
Practice Address - Street 1:1413 CARPENTER FLETCHER RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2007
Practice Address - Country:US
Practice Address - Phone:919-544-6461
Practice Address - Fax:919-361-2487
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF96870Medicare UPIN
NC2203887Medicare ID - Type Unspecified