Basic Information
| Provider Information | |||||||||
| NPI: | 1972591550 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | TOON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9910 FRANKLIN SQUARE DR # 2110 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212364902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109335412 | ||||||||
| FaxNumber: | 4109331390 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 I ST NW STE 825 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026172160 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2005 | ||||||||
| LastUpdateDate: | 05/29/2018 | ||||||||
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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 | 207R00000X | 0102050256 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DO31453 | DC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 71050002 | 01 | BLUECROSS/BLUE SHIELD | OTHER | 7929081 | 01 | AETNA HEALTHCARE | OTHER | 027140900 | 05 | DC | MEDICAID | 500134 | 01 | NCPPO | OTHER | 337638 | 01 | VA | ANTHEM BC/BS | OTHER | 337639 | 01 | DC | ANTHEM BC/BS | OTHER | 5861152 | 05 | VA | MEDICAID | 773600200 | 05 | MD | MEDICAID |