Provider Demographics
NPI:1245902436
Name:LEE, GREGORY BRIAN (L AC)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:BRIAN
Last Name:LEE
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 ROCKDALE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-8229
Mailing Address - Country:US
Mailing Address - Phone:301-228-3764
Mailing Address - Fax:
Practice Address - Street 1:4539 METROPOLITAN CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-9452
Practice Address - Country:US
Practice Address - Phone:301-228-3764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU-00652171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist