Healthcare Provider Details

I. General information

NPI: 1679577092
Provider Name (Legal Business Name): ZORAYDA M LEE-LLACER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 BAYSIDE DR
STEVENSVILLE MD
21666-2734
US

IV. Provider business mailing address

8909 OLD BRANCH AVE
CLINTON MD
20735-2528
US

V. Phone/Fax

Practice location:
  • Phone: 202-239-5888
  • Fax: 301-868-9098
Mailing address:
  • Phone: 301-868-7274
  • Fax: 301-868-9098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0012962
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0012962
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: