Basic Information
| Provider Information | |||||||||
| NPI: | 1639215700 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | KRISTI | ||||||||
| MiddleName: | ALETHEA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HUBBARD | ||||||||
| OtherFirstName: | KRISTI | ||||||||
| OtherMiddleName: | ALETHEA | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 803 RUSSELL AVE | ||||||||
| Address2: | SUITE #1 | ||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208793584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018690700 | ||||||||
| FaxNumber: | 3019481751 | ||||||||
| Practice Location | |||||||||
| Address1: | 803 RUSSELL AVE | ||||||||
| Address2: | SUITE #1 | ||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208793584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018690700 | ||||||||
| FaxNumber: | 3019481751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 09/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D0059377 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.