Provider Demographics
NPI:1174268080
Name:MCLEE, VENTURA DEREK
Entity Type:Individual
Prefix:
First Name:VENTURA
Middle Name:DEREK
Last Name:MCLEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9805 DAMERON DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5717
Mailing Address - Country:US
Mailing Address - Phone:443-326-5964
Mailing Address - Fax:
Practice Address - Street 1:5214 BEAUFORT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5021
Practice Address - Country:US
Practice Address - Phone:443-326-5964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty