Provider Demographics
NPI:1477276459
Name:LEE, DARLENE TOWANDA
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:TOWANDA
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 NORTHWAY DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-7826
Mailing Address - Country:US
Mailing Address - Phone:210-240-4571
Mailing Address - Fax:
Practice Address - Street 1:3207 NORTHWAY DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-7826
Practice Address - Country:US
Practice Address - Phone:410-240-4571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP4F2T6Y8246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP4F2T6Y8OtherCERTIFICATION NUMBER