Provider Demographics
NPI:1679577092
Name:LEE-LLACER, ZORAYDA M (MD)
Entity Type:Individual
Prefix:
First Name:ZORAYDA
Middle Name:M
Last Name:LEE-LLACER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8909 OLD BRANCH AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2528
Mailing Address - Country:US
Mailing Address - Phone:301-868-7274
Mailing Address - Fax:301-868-9098
Practice Address - Street 1:8909 OLD BRANCH AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2528
Practice Address - Country:US
Practice Address - Phone:301-868-7274
Practice Address - Fax:301-868-9098
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0012962207L00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
66770001OtherCAREFIRST
MD250371900Medicaid
MD250371900Medicaid
MD409970Medicare UPIN