Provider Demographics
NPI:1154393650
Name:LEE, VICTOR C
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-4629
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:70 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 305
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2332
Practice Address - Country:US
Practice Address - Phone:540-932-5747
Practice Address - Fax:540-932-5748
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040612207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005712980Medicaid
VA22378OtherOPTIMA
VA25007OtherCIGNA
VA394635OtherANTHEM
VA147162OtherSOUTHERN HEALTH
VA5712980OtherVA PREMIER
VA2202266OtherFIRST HEALTH
VA22378OtherOPTIMA
VA005712980Medicaid
VAGC1100Medicare PIN
VA2202266OtherFIRST HEALTH
VAC36541Medicare UPIN