Provider Demographics
NPI:1114405537
Name:LEE, BAEKCHEOL (NP)
Entity type:Individual
Prefix:
First Name:BAEKCHEOL
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14509 ANCHOR LN
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-4007
Mailing Address - Country:US
Mailing Address - Phone:240-888-6512
Mailing Address - Fax:240-349-7832
Practice Address - Street 1:19537 DOCTORS DR # 1B
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5262
Practice Address - Country:US
Practice Address - Phone:240-654-4001
Practice Address - Fax:240-349-7832
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR207157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily