Active NPI
Bothwell Graves Lee, M.D.
- Neurological Surgery Physician
- Salisbury, MD
National Provider Identifier
1043320252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurological Surgery Physician
- License
- D0057234
- Practice address
- 1630 Woodbrooke Dr
Salisbury, MD 21804-8501 - Phone
- (410) 912-6330
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | 0101221427 | VA | |
| Neurological Surgery Physician | 207T00000X | D0057234 | MD | Primary |
Addresses
Primary practice location
1630 Woodbrooke Dr
Salisbury, MD 21804-8501
Mailing address
100 E Carroll St
Salisbury, MD 21801-5422
Phone (800) 749-5191
Other practice location 1
8101 Hinson Farm Rd
Suite 112
Alexandria, VA 22306-3403
Phone (703) 780-7908
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 581314YTQ | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562803200000",
"number": "1043320252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 E CARROLL ST",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218015422",
"telephone_number": "800-749-5191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1630 WOODBROOKE DR",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218048501",
"telephone_number": "410-912-6330"
}
],
"practiceLocations": [
{
"address_1": "8101 Hinson Farm Rd",
"address_2": "Suite 112",
"address_purpose": "LOCATION",
"city": "Alexandria",
"state": "VA",
"postal_code": "223063403",
"country_code": "US",
"telephone_number": "703-780-7908",
"fax_number": "703-799-2118",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEE",
"first_name": "BOTHWELL",
"middle_name": "GRAVES",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2019-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "207T00000X",
"taxonomy_group": "",
"desc": "Neurological Surgery",
"state": "VA",
"license": "0101221427",
"primary": false
},
{
"code": "207T00000X",
"taxonomy_group": "",
"desc": "Neurological Surgery",
"state": "MD",
"license": "D0057234",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "581314YTQ",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salisbury, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.