Provider Demographics
NPI:1477566875
Name:LEE-LLACER, REYNALDO LABITAG II (MD)
Entity Type:Individual
Prefix:DR
First Name:REYNALDO
Middle Name:LABITAG
Last Name:LEE-LLACER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8600 SNOWDEN RIVER PKWY
Mailing Address - Street 2:SUITE 307
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1982
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 CATON AVE
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5201
Practice Address - Country:US
Practice Address - Phone:410-368-6000
Practice Address - Fax:410-368-3599
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0061829207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406470400Medicaid
122122OtherJHHC
270887.OtherAMERIGROUP
1503644OtherAETNA HMO
0041OtherCAREFIRST
64241604OtherCAREFIRST
7832636OtherAETNA PPO
I08845Medicare UPIN
1503644OtherAETNA HMO
7832636OtherAETNA PPO
H360K331Medicare PIN