Provider Demographics
NPI:1265792501
Name:PENG, LEI (MD)
Entity type:Individual
Prefix:
First Name:LEI
Middle Name:
Last Name:PENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-500-4266
Practice Address - Street 1:8081 INNOVATION PARK DR STE 765
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4867
Practice Address - Country:US
Practice Address - Phone:571-472-1717
Practice Address - Fax:571-472-1718
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2024-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD84351207RX0202X, 2080P0207X
VA01012818322080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD84351OtherLICENSE