Provider Demographics
NPI:1104813427
Name:LEE, JOHN C (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:LEE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2006 BREMO RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2438
Mailing Address - Country:US
Mailing Address - Phone:804-288-1881
Mailing Address - Fax:804-282-6413
Practice Address - Street 1:2006 BREMO RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2438
Practice Address - Country:US
Practice Address - Phone:804-288-1881
Practice Address - Fax:804-282-6413
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01011026692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH78691Medicare UPIN