Provider Demographics
NPI:1780249714
Name:LEE, MCKENZIE
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VCUHS GMEA
Mailing Address - Street 2:BOX 980257
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0257
Mailing Address - Country:US
Mailing Address - Phone:804-828-9783
Mailing Address - Fax:
Practice Address - Street 1:VCUHS DEPT OF SURGERY RESIDENCY, 980645
Practice Address - Street 2:1250 E. MARSHALL STREET
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0645
Practice Address - Country:US
Practice Address - Phone:804-828-7874
Practice Address - Fax:804-827-1016
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1780249714208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery