Provider Demographics
NPI:1518953074
Name:LEE, JOSEPH I (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:I
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 1:3340 ROBINWOOD RD STE 100-534
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-6689
Mailing Address - Country:US
Mailing Address - Phone:980-233-3234
Mailing Address - Fax:
Practice Address - Street 1:6500 ROCK SPRING DR STE 105
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1154
Practice Address - Country:US
Practice Address - Phone:301-530-8300
Practice Address - Fax:301-530-4638
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051599207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD004095YD9GMedicare PIN
G45891Medicare UPIN
MD004095YD9GMedicare PIN