Provider Demographics
NPI:1326345828
Name:HALLER, LEE HIGDON (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:HIGDON
Last Name:HALLER
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 1:9800 FALLS RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3999
Mailing Address - Country:US
Mailing Address - Phone:301-983-5211
Mailing Address - Fax:301-983-5213
Practice Address - Street 1:9800 FALLS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3999
Practice Address - Country:US
Practice Address - Phone:301-983-5211
Practice Address - Fax:301-983-5213
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD235162084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1558355644OtherNPI TYPE 2
MD151003Medicare PIN
MD1558355644OtherNPI TYPE 2