Provider Demographics
NPI:1356329981
Name:LEE, ERIC S (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:S
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 1:7501 GREENWAY CENTER DR # 300
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3514
Mailing Address - Country:US
Mailing Address - Phone:301-474-4679
Mailing Address - Fax:
Practice Address - Street 1:200 EXECUTIVE CENTER PARKWAY R.G.W.
Practice Address - Street 2:SUITE 102
Practice Address - City:FREDERICKBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-654-5333
Practice Address - Fax:540-654-5334
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD68270207W00000X, 207WX0107X
VA0101244140207W00000X, 207WX0107X
DCMD037531207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC057040400Medicaid
VA1356329981Medicaid
MD570113900Medicaid
DC057040400Medicaid
DC167151Y2FMedicare PIN