Provider Demographics
NPI:1114192432
Name:LEE, GLORIA I (MD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:I
Last Name:LEE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 ROCKVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1133
Mailing Address - Country:US
Mailing Address - Phone:301-424-0658
Mailing Address - Fax:
Practice Address - Street 1:750 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1133
Practice Address - Country:US
Practice Address - Phone:014-240-6583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243264207Q00000X
OH35-09165207Q00000X
CAA110209207Q00000X
CO53684207Q00000X
MDD84099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine