Provider Demographics
NPI:1477566875
Name:LEE-LLACER, REYNALDO LABITAG II (MD)
Entity type:Individual
Prefix:
First Name:REYNALDO
Middle Name:LABITAG
Last Name:LEE-LLACER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 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 1:8600 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:410-290-0012
Practice Address - Fax:410-290-0015
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061829207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
270887.OtherAMERIGROUP
MD406470400Medicaid
7832636OtherAETNA PPO
0041OtherCAREFIRST
122122OtherJHHC
1503644OtherAETNA HMO
64241604OtherCAREFIRST
I08845Medicare UPIN
1503644OtherAETNA HMO
7832636OtherAETNA PPO
H360K331Medicare PIN