Provider Demographics
NPI:1639215700
Name:LEE, KRISTI ALETHEA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:ALETHEA
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTI
Other - Middle Name:ALETHEA
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:803 RUSSELL AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3584
Mailing Address - Country:US
Mailing Address - Phone:301-869-0700
Mailing Address - Fax:301-948-1751
Practice Address - Street 1:803 RUSSELL AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3584
Practice Address - Country:US
Practice Address - Phone:301-869-0700
Practice Address - Fax:301-948-1751
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH88958Medicare UPIN
MD010717L71Medicare ID - Type Unspecified