Provider Demographics
NPI:1639190028
Name:LEE, ROLAND ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:ROBERT
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:VA MED CENTER/UCSD RADIOLOGY # MC114
Mailing Address - Street 2:3350 LA JOLLA VILLAGE DRIVE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-0001
Mailing Address - Country:US
Mailing Address - Phone:858-552-8585
Mailing Address - Fax:858-552-7565
Practice Address - Street 1:VA MED CENTER/UCSD RADIOLOGY # MC114
Practice Address - Street 2:3350 LA JOLLA VILLAGE DRIVE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0001
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:858-552-7565
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG578002085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G578000Medicaid
CAWG57800BMedicare ID - Type Unspecified
CA00G578000Medicaid