Provider Demographics
NPI:1154342996
Name:LEE, SEO RYONG (MD)
Entity type:Individual
Prefix:
First Name:SEO RYONG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13202 RIPPLING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5312
Mailing Address - Country:US
Mailing Address - Phone:301-871-2221
Mailing Address - Fax:301-871-9757
Practice Address - Street 1:13202 RIPPLING BROOK DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-5312
Practice Address - Country:US
Practice Address - Phone:301-871-2220
Practice Address - Fax:301-871-9757
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024793207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C62069Medicare UPIN
153975Medicare ID - Type Unspecified