Provider Demographics
NPI:1780837740
Name:LEE, NEWTON (DOM, LAC)
Entity Type:Individual
Prefix:
First Name:NEWTON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43656 INTREPID ST
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-3689
Mailing Address - Country:US
Mailing Address - Phone:703-283-8717
Mailing Address - Fax:
Practice Address - Street 1:19415 DEERFIELD AVE STE 201
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8471
Practice Address - Country:US
Practice Address - Phone:703-890-0487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000528171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist