Provider Demographics
NPI:1922135508
Name:LEE-LLACER & LEE-LLACER, MD,PA
Entity type:Organization
Organization Name:LEE-LLACER & LEE-LLACER, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-290-0255
Mailing Address - Street 1:818 BAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2734
Mailing Address - Country:US
Mailing Address - Phone:410-290-0255
Mailing Address - Fax:
Practice Address - Street 1:818 BAYSIDE DR
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2734
Practice Address - Country:US
Practice Address - Phone:410-290-0255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0012962207L00000X, 207RC0200X
MDD008273208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty