Provider Demographics
NPI:1699775718
Name:CONGLETON, LEE III (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:CONGLETON
Suffix:III
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 GRAND CENTRAL AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7557 DANNAHER DR STE 230
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3563
Practice Address - Country:US
Practice Address - Phone:865-938-5222
Practice Address - Fax:865-938-5264
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000020494208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN020253199OtherEEOICP
TN3052785Medicaid
TN1669416442OtherGROUP NPI
TN3106079OtherBLUE CROSS
TN3106070OtherBLUE CROSS
TNCI2260OtherRAILROAD MEDICARE
TN020253199OtherEEOICP
TN3052785Medicaid
TN3714756Medicare PIN
TN3106070OtherBLUE CROSS
TN3714755Medicare PIN