MEDICARE: LEE-LLACER & LEE-LLACER, MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	207LC0200X	Critical Care Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1144314899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE-LLACER & LEE-LLACER, MD PA

Provider Business Mailing Address
First Line	:	8600 SNOWDEN RIVER PKWY STE 307
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1986
Country	:	US
Telephone Number	:	410-290-0255
Fax Number	:	410-862-2775

Provider Business Practice Location Address
First Line	:	818 BAYSIDE DR
Second Line	:
City	:	STEVENSVILLE
State	:	MD
Zip	:	21666-2734
Country	:	US
Telephone Number	:	202-239-5888
Fax Number	:	202-403-0508

Authorized Official
Title or Position	:	COO
Name	:	CARAOL BALTAZAR
Credential	:
Telephone Number	:	410-290-0255

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	10/03/2025

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