Provider Demographics
NPI:1154360675
Name:LEE, WENDY W (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:W
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 NIGELS DRIVE
Mailing Address - Street 2:CAROLINA RHEUMATOLOGY & NEUROLOGY
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572
Mailing Address - Country:US
Mailing Address - Phone:843-692-0968
Mailing Address - Fax:
Practice Address - Street 1:8220 NIGELS DR
Practice Address - Street 2:CAROLINA RHEUMATOLOGY & NEUROLOGY
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4125
Practice Address - Country:US
Practice Address - Phone:843-692-0968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19144207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC191447Medicaid
SCG4028066954Medicare ID - Type Unspecified
SC191447Medicaid