Individual
IRVIN LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
2401 W BELVEDERE AVE, BALTIMORE, MD 21215-5216
(410) 601-5209
Mailing address
PO BOX 3038, PINEDALE, CA 93650-3038
(559) 436-0871
(559) 436-5221
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R163033
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
404268900
—
MD
01
—
454MI519
TRAILBLAZER
MD
Enumeration date
06/30/2005
Last updated
06/06/2018
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