Provider Demographics
NPI:1578622312
Name:LEE, CHARLOTTE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:CHARLOTTE
Other - Middle Name:MARIE
Other - Last Name:LANGENDERFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4881 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:WRIGHT PATTERSON AFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433-5529
Mailing Address - Country:US
Mailing Address - Phone:937-257-1942
Mailing Address - Fax:937-656-1347
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:WPAFB
Practice Address - State:OH
Practice Address - Zip Code:45433-5529
Practice Address - Country:US
Practice Address - Phone:937-257-1942
Practice Address - Fax:937-656-1347
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00432208000000X
NV13211208000000X
FLME138588208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics