Provider Demographics
NPI:1588655005
Name:LEE, JOHN H (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2722 MERRILEE DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4400
Mailing Address - Country:US
Mailing Address - Phone:703-698-4483
Mailing Address - Fax:703-573-0880
Practice Address - Street 1:2722 MERRILEE DR
Practice Address - Street 2:SUITE 230
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4400
Practice Address - Country:US
Practice Address - Phone:703-698-4483
Practice Address - Fax:703-573-0880
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012400762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006594Medicaid
VA0091OtherCAREFIRST BCBS
VA259989OtherKAISER
VA1536346OtherAETNA HMO
VA7974929OtherAETNA
VA0091OtherCAREFIRST BCBS
VA259989OtherKAISER
WV3810006594Medicaid