Provider Demographics
NPI:1336104140
Name:LEE, SUSAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11301 BISHOPS GATE LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-2052
Mailing Address - Country:US
Mailing Address - Phone:410-792-2170
Mailing Address - Fax:
Practice Address - Street 1:9501 OLD ANNAPOLIS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6314
Practice Address - Country:US
Practice Address - Phone:410-992-9339
Practice Address - Fax:410-964-5150
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2023-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0058964208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD510113100Medicaid