Basic Information
| Provider Information | |||||||||
| NPI: | 1548251671 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 HOSPITAL DR | ||||||||
| Address2: | STE 132 | ||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210616902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105538260 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4231 POSTAL CT | ||||||||
| Address2: | STE 102 | ||||||||
| City: | PASADENA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211224439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105538260 | ||||||||
| FaxNumber: | 4107874846 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 07/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | D0056094 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 7976011 00 | 05 | MD | MEDICAID | 154002500 | 05 | MD | MEDICAID |