Provider Demographics
NPI:1659370641
Name:FIRESTONE, LEE EDWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:EDWARD
Last Name:FIRESTONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 K ST NW
Mailing Address - Street 2:SUITE 520
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1003
Mailing Address - Country:US
Mailing Address - Phone:202-223-4616
Mailing Address - Fax:202-223-0740
Practice Address - Street 1:2021 K ST NW
Practice Address - Street 2:SUITE 520
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1003
Practice Address - Country:US
Practice Address - Phone:202-223-4616
Practice Address - Fax:202-223-0740
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1204213E00000X
DCP0546213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0797367 00Medicaid
DCU50664Medicare UPIN
DCG00404Medicare ID - Type Unspecified
MD0797367 00Medicaid