Basic Information
| Provider Information | |||||||||
| NPI: | 1568452258 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1910 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226048060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668784221 | ||||||||
| FaxNumber: | 5405364359 | ||||||||
| Practice Location | |||||||||
| Address1: | 1840 AMHERST ST | ||||||||
| Address2: | STE 4C | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405367897 | ||||||||
| FaxNumber: | 5405367843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | 0101057733 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 006726828 | 05 | VA | MEDICAID | 0111639000 | 05 | WV | MEDICAID | 204887 | 01 | VA | ANTHEM | OTHER | 200480770 | 05 | IN | MEDICAID | 400188500 | 05 | MD | MEDICAID | 1881956 | 05 | PA | MEDICAID |