Healthcare Provider Details

I. General information

NPI: 1144314899
Provider Name (Legal Business Name): LEE-LLACER & LEE-LLACER, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 BAYSIDE DR
STEVENSVILLE MD
21666-2734
US

IV. Provider business mailing address

8600 SNOWDEN RIVER PKWY STE 307
COLUMBIA MD
21045-1986
US

V. Phone/Fax

Practice location:
  • Phone: 202-239-5888
  • Fax: 202-403-0508
Mailing address:
  • Phone: 410-290-0255
  • Fax: 410-862-2775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CARAOL BALTAZAR
Title or Position: COO
Credential:
Phone: 410-290-0255