Provider Demographics
NPI:1952305609
Name:LEE, DANE (MD)
Entity Type:Individual
Prefix:
First Name:DANE
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 1:24530 FALCON PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-7657
Mailing Address - Country:US
Mailing Address - Phone:276-619-0075
Mailing Address - Fax:276-619-0077
Practice Address - Street 1:24530 FALCON PLACE BLVD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7657
Practice Address - Country:US
Practice Address - Phone:276-619-0075
Practice Address - Fax:276-619-0077
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 34234207Q00000X
VA0101054251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F62571Medicare UPIN
VAV V5977AMedicare PIN
TN103I086960Medicare PIN