Basic Information
| Provider Information | |||||||||
| NPI: | 1659734853 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | RANDALL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2120 L ST NW | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200371541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027412904 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2120 L. STREET, NW | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027412904 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2016 | ||||||||
| LastUpdateDate: | 04/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | A153362 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD048320 | DC | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.