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General NPI Number Information
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NPI Number | 1922135508
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Entity Type | Organization
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Legal Business Name | LEE-LLACER & LEE-LLACER, MD,PA
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 818 BAYSIDE DR
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City | STEVENSVILLE
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State | MD
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Zip | 21666-2734
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Country | US
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Telephone | 410-290-0255
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Fax |
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Provider Business Mailing Address
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Address Line | 818 BAYSIDE DR
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City | STEVENSVILLE
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State | MD
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Zip | 21666-2734
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Country | US
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Telephone | 410-290-0255
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Fax |
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Authorized Official
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Title or Position | COO
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Name | CAROL BALTAZAR
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Credential |
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Telephone | 410-290-0255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | D0012962
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | D008273
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | D0012962
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License Number State | MD
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