Provider Demographics
NPI:1144314899
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:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-239-5888
Mailing Address - Street 1:8909 OLD BRANCH AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735
Mailing Address - Country:US
Mailing Address - Phone:301-868-7274
Mailing Address - Fax:301-868-9098
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:202-239-5888
Practice Address - Fax:202-403-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409970Medicare ID - Type UnspecifiedPROV NUMBER