Provider Demographics
NPI:1518017441
Name:LEE, SUONG K (MD)
Entity Type:Individual
Prefix:
First Name:SUONG
Middle Name:K
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:PO BOX 1248
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21741-1248
Mailing Address - Country:US
Mailing Address - Phone:800-938-2828
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:11116 MEDICAL CAMPUS RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6710
Practice Address - Country:US
Practice Address - Phone:301-665-1717
Practice Address - Fax:301-665-1810
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240994207L00000X, 207LP2900X
MDD0067379207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD416577200Medicaid
MDP00989628OtherRAILROAD MEDICARE
MDP00989628OtherRAILROAD MEDICARE
MD416577200Medicaid