Provider Demographics
NPI:1255366944
Name:LEE, TIMOTHY N (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:N
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 1:2800 GODWIN BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8038
Mailing Address - Country:US
Mailing Address - Phone:757-934-4162
Mailing Address - Fax:757-934-4246
Practice Address - Street 1:919 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-1715
Practice Address - Country:US
Practice Address - Phone:757-365-8018
Practice Address - Fax:757-356-9451
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005620015Medicaid
VA393618OtherANTHEM PROVIDER NUMBER
VA393618OtherANTHEM PROVIDER NUMBER
VA080007914Medicare ID - Type Unspecified