Basic Information
Provider Information | |||||||||
NPI: | 1700825387 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LEE | ||||||||
FirstName: | MILLIE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 844 KEMPSVILLE RD | ||||||||
Address2: | STE 204 | ||||||||
City: | NORFOLK | ||||||||
State: | VA | ||||||||
PostalCode: | 235023927 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7572610700 | ||||||||
FaxNumber: | 7572610701 | ||||||||
Practice Location | |||||||||
Address1: | 844 KEMPSVILLE RD | ||||||||
Address2: | SUITE 204 | ||||||||
City: | NORFOLK | ||||||||
State: | VA | ||||||||
PostalCode: | 235023927 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7572610700 | ||||||||
FaxNumber: | 7579621254 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/06/2006 | ||||||||
LastUpdateDate: | 05/08/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 0101227517 | VA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
ID | Type | State | Issuer | Description | -001 | 01 | VA | TRICARE/ CHAMPUS | OTHER | 1700825387 | 05 | VA |   | MEDICAID | 2161776 | 01 | VA | UHC/MAMSI | OTHER | PAR | 01 | VA | CORVEL/CORCARE | OTHER | PAR | 01 | VA | VIRGINIA PREMIER HEALTH | OTHER | 010147361 | 05 | VA |   | MEDICAID | 5900444 | 05 | NC |   | MEDICAID | 93673 | 01 | VA | OPTIMA HEALTH PLAN | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | 2131997 | 01 | VA | MAMSI | OTHER | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER | 175624 | 01 | VA | ANTHEM BC/BS AND HKP | OTHER | PAR | 01 | VA | CIGNA | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | 00444 | 01 | NC | BC/BS | OTHER | 10015343 | 01 | VA | SENTARA OPTIMA | OTHER | 281332 | 01 | VA | ANTHEM | OTHER | PAR | 01 | VA | AETNA | OTHER |