Basic Information
| Provider Information | |||||||||
| NPI: | 1518017441 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | SUONG | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1248 | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217411248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009382828 | ||||||||
| FaxNumber: | 3027330854 | ||||||||
| Practice Location | |||||||||
| Address1: | 11116 MEDICAL CAMPUS RD | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217426710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016651717 | ||||||||
| FaxNumber: | 3016651810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 04/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101240994 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | D0067379 | MD | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 0101240994 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 416577200 | 05 | MD | MEDICAID | P00989628 | 01 | MD | RAILROAD MEDICARE | OTHER |