Individual
MOLLY E LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-1239
(843) 792-1414
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01090331A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068010904
MEDICARE PTAN
IN
Enumeration date
04/15/2020
Last updated
04/19/2024
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