Provider Demographics
NPI:1982692471
Name:LEE, BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
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:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-0997
Mailing Address - Country:US
Mailing Address - Phone:443-490-4000
Mailing Address - Fax:443-484-2831
Practice Address - Street 1:2012 S. TOLLGATE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-5901
Practice Address - Country:US
Practice Address - Phone:443-490-4000
Practice Address - Fax:443-484-2831
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057974207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003003100Medicaid
F88893Medicare UPIN
MD468SMedicare PIN
MD6472160001Medicare NSC