Provider Demographics
NPI:1689675837
Name:LEE, ALFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WADSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4521
Mailing Address - Country:US
Mailing Address - Phone:804-330-4901
Mailing Address - Fax:804-330-9145
Practice Address - Street 1:16011 KAIROS RD
Practice Address - Street 2:STE 300
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23834-5207
Practice Address - Country:US
Practice Address - Phone:804-520-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033290207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6043011Medicaid
VA6043011Medicaid
VA110002648Medicare ID - Type Unspecified