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	207L00000X	Anesthesiology Physician	D0012962	MD
2	208600000X	Surgery Physician	D008273	MD
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	D0012962	MD

General Provider Information

NPI Number	:	1922135508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE-LLACER & LEE-LLACER, MD,PA

Provider Business Mailing Address
First Line	:	818 BAYSIDE DR
Second Line	:
City	:	STEVENSVILLE
State	:	MD
Zip	:	21666-2734
Country	:	US
Telephone Number	:	410-290-0255
Fax Number	:

Provider Business Practice Location Address
First Line	:	818 BAYSIDE DR
Second Line	:
City	:	STEVENSVILLE
State	:	MD
Zip	:	21666-2734
Country	:	US
Telephone Number	:	410-290-0255
Fax Number	:

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/28/2025

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