Provider Demographics
NPI:1568452258
Name:LEE, EDWARD I (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:I
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:PO BOX 1910
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22604-8060
Mailing Address - Country:US
Mailing Address - Phone:866-878-4221
Mailing Address - Fax:540-536-4359
Practice Address - Street 1:1840 AMHERST ST
Practice Address - Street 2:STE 4C
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-7897
Practice Address - Fax:540-536-7843
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010577332080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006726828Medicaid
WV0111639000Medicaid
VA204887OtherANTHEM
IN200480770Medicaid
MD400188500Medicaid
PA1881956Medicaid