Provider Demographics
NPI:1558512673
Name:EDWIN J LEE MD PC
Entity Type:Organization
Organization Name:EDWIN J LEE MD PC
Other - Org Name:ASHBURN EAR NOSE AND THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-787-3322
Mailing Address - Street 1:1860 TOWN CENTER DR
Mailing Address - Street 2:SUITE 335
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5896
Mailing Address - Country:US
Mailing Address - Phone:703-787-3322
Mailing Address - Fax:703-787-3380
Practice Address - Street 1:43480 YUKON DR
Practice Address - Street 2:SUITE 214
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6988
Practice Address - Country:US
Practice Address - Phone:703-787-3322
Practice Address - Fax:703-787-3380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDWIN J LEE MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236481207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty