Provider Demographics
NPI:1700581550
Name:LEE, RANDOLPH JAMES
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:JAMES
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 23RD ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-4705
Mailing Address - Country:US
Mailing Address - Phone:757-593-0153
Mailing Address - Fax:
Practice Address - Street 1:1151 23RD ST
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-4705
Practice Address - Country:US
Practice Address - Phone:757-985-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)