Provider Demographics
NPI:1346423381
Name:LEE, VICKIE KYURAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKIE
Middle Name:KYURAN
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44320 PREMIER PLZ
Mailing Address - Street 2:SUITE #110
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5076
Mailing Address - Country:US
Mailing Address - Phone:703-723-8727
Mailing Address - Fax:703-723-9787
Practice Address - Street 1:44320 PREMIER PLZ
Practice Address - Street 2:SUITE #110
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5076
Practice Address - Country:US
Practice Address - Phone:703-723-8727
Practice Address - Fax:703-723-9787
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242747207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3179242OtherONENET
VA1346423381Medicaid
VA4569213OtherCIGNA
VA952108OtherAETNA
VAD393-0001OtherCAREFIRST BCBS