Provider Demographics
NPI:1578582094
Name:LEE, YOUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603C S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5814
Mailing Address - Country:US
Mailing Address - Phone:804-861-0738
Mailing Address - Fax:804-861-4692
Practice Address - Street 1:603C S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5814
Practice Address - Country:US
Practice Address - Phone:804-861-0738
Practice Address - Fax:804-861-4692
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031989207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB08162Medicare UPIN