Provider Demographics
NPI:1730156746
Name:LEE, BENJAMIN S (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:700 GEIPE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4147
Mailing Address - Country:US
Mailing Address - Phone:410-744-7184
Mailing Address - Fax:410-744-1176
Practice Address - Street 1:700 GEIPE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4147
Practice Address - Country:US
Practice Address - Phone:410-744-7184
Practice Address - Fax:410-744-1176
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0052544207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD904310100Medicaid
MD904310100Medicaid
G56861Medicare UPIN