Provider Demographics
NPI:1730376583
Name:LEE, BRIAN JEN (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JEN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2633 GOLF ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2287
Mailing Address - Country:US
Mailing Address - Phone:410-978-9796
Mailing Address - Fax:
Practice Address - Street 1:3290 N RIDGE RD STE 250
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3659
Practice Address - Country:US
Practice Address - Phone:443-574-4719
Practice Address - Fax:877-369-5380
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093681207W00000X
OH57010750207W00000X
MDD0071864207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology