Provider Demographics
NPI:1619079571
Name:LEE, KENNETH STUART (M D)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:STUART
Last Name:LEE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 STANTONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2325 STANTONSBURG RD
Practice Address - Street 2:ECU PHYSICIANS BEUROSURGICAL & SPINE CENTER
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7534
Practice Address - Country:US
Practice Address - Phone:252-752-5156
Practice Address - Fax:252-752-0419
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17725207T00000X
NC27482207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC51512OtherBCBS NC
NC7951512Medicaid
NCP00709998OtherRAILROAD MEDICARE
NC51512OtherBCBS NC