Provider Demographics
NPI:1699578989
Name:DR REYNALDO LEE-LLACER II PC
Entity type:Organization
Organization Name:DR REYNALDO LEE-LLACER II PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE-LLACER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:410-290-0255
Mailing Address - Street 1:8600 SNOWDEN RIVER PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1986
Mailing Address - Country:US
Mailing Address - Phone:410-290-0255
Mailing Address - Fax:410-862-2775
Practice Address - Street 1:8600 SNOWDEN RIVER PKWY STE 307
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1986
Practice Address - Country:US
Practice Address - Phone:410-290-0255
Practice Address - Fax:410-862-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty