Provider Demographics
NPI:1932167376
Name:LEE, BENJAMIN P (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:P
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 1:319 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112
Mailing Address - Country:US
Mailing Address - Phone:276-634-4976
Mailing Address - Fax:276-634-1942
Practice Address - Street 1:319 HOSPITAL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1929
Practice Address - Country:US
Practice Address - Phone:276-634-4976
Practice Address - Fax:276-634-1942
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058000207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1932167376Medicaid
VA015944R53Medicare PIN
I30787Medicare UPIN
VAP00670746Medicare PIN