Provider Demographics
NPI:1275591364
Name:LEE, JAMES J (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:LEE
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 1:10700 CHARTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3631
Mailing Address - Country:US
Mailing Address - Phone:410-992-7800
Mailing Address - Fax:410-720-2190
Practice Address - Street 1:10700 CHARTER DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3631
Practice Address - Country:US
Practice Address - Phone:410-992-7800
Practice Address - Fax:410-720-2190
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD865332081P2900X, 208100000X, 208VP0014X
MA207397208100000X, 2081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA36624OtherHARVARD PILGRIM HEALTHCAR
MA0113191Medicaid
MA207397OtherTUFTS HEALTH PLAN
MAJ22437OtherBLUE CROSS/BLUE SHIELD
MAH16376Medicare UPIN
MAA3108301Medicare PIN
MA0113191Medicaid