Basic Information
| Provider Information | |||||||||
| NPI: | 1275993537 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | ARTHUR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6931 RED CLAY FRG | ||||||||
| Address2: | UNIT 308 | ||||||||
| City: | ELKRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210756375 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 215 BLOOMINGDALE AVE | ||||||||
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| City: | FEDERALSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216321012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107547583 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/29/2016 | ||||||||
| LastUpdateDate: | 04/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.