Provider Demographics
NPI:1720170855
Name:LEE, INSOOK (MD)
Entity type:Individual
Prefix:
First Name:INSOOK
Middle Name:
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 1:4050 INNSLAKE DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3327
Mailing Address - Country:US
Mailing Address - Phone:804-521-5315
Mailing Address - Fax:804-521-5312
Practice Address - Street 1:4050 INNSLAKE DR
Practice Address - Street 2:SUITE 308
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3327
Practice Address - Country:US
Practice Address - Phone:804-521-5315
Practice Address - Fax:804-521-5312
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
302011OtherANTHEM
VA58-83504Medicaid
1451464OtherCIGNA
VA1720170855Medicaid
001055C18Medicare ID - Type Unspecified
1451464OtherCIGNA
VAMC11898Medicare PIN