Provider Demographics
NPI:1902234032
Name:CHARLOTTE A. LEE, M.D., P.A.
Entity Type:Organization
Organization Name:CHARLOTTE A. LEE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-706-8512
Mailing Address - Street 1:1770 AVENIDA DEL MUNDO
Mailing Address - Street 2:SUITE 903
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3042
Mailing Address - Country:US
Mailing Address - Phone:913-706-8512
Mailing Address - Fax:
Practice Address - Street 1:1770 AVENIDA DEL MUNDO
Practice Address - Street 2:SUITE 903
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-3042
Practice Address - Country:US
Practice Address - Phone:913-706-8512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27077174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty