Provider Demographics
NPI:1659033116
Name:LEE, JEFFREY K
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:K
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 1:68 THOMAS JOHNSON DR STE C
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4901
Mailing Address - Country:US
Mailing Address - Phone:301-694-5292
Mailing Address - Fax:
Practice Address - Street 1:68 THOMAS JOHNSON DR STE C
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4901
Practice Address - Country:US
Practice Address - Phone:301-694-5292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2025-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0008586363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant