Provider Demographics
NPI:1780893917
Name:LEE, MATTHEW C (MD, RPH)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:MD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-6518
Mailing Address - Country:US
Mailing Address - Phone:804-648-3388
Mailing Address - Fax:
Practice Address - Street 1:1617 MONUMENT AVE STE 302
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-2943
Practice Address - Country:US
Practice Address - Phone:804-358-1492
Practice Address - Fax:804-358-1941
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2009-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011774183500000X
VA0101239897207Q00000X, 208D00000X, 208U00000X, 207R00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No183500000XPharmacy Service ProvidersPharmacist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190001980Medicare PIN