Provider Demographics
NPI:1134157803
Name:LEE, MARIA AK (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:AK
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5217
Mailing Address - Country:US
Mailing Address - Phone:256-543-1865
Mailing Address - Fax:256-546-1878
Practice Address - Street 1:510 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5217
Practice Address - Country:US
Practice Address - Phone:256-543-1865
Practice Address - Fax:256-546-1878
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25920174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009952155Medicaid
ALG77822Medicare UPIN