1477566875 NPI number — REYNALDO LABITAG LEE-LLACER II M.D.

Table of content: REYNALDO LABITAG LEE-LLACER II M.D. (NPI 1477566875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477566875 NPI number — REYNALDO LABITAG LEE-LLACER II M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE-LLACER
Provider First Name:
REYNALDO
Provider Middle Name:
LABITAG
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477566875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8600 SNOWDEN RIVER PKWY
Provider Second Line Business Mailing Address:
SUITE 307
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21045-1982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8600 SNOWDEN RIVER PKWY STE 307
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-1986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-290-0012
Provider Business Practice Location Address Fax Number:
410-290-0015
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D0061829 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 270887. . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 406470400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7832636 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0041 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 122122 . This is a "JHHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1503644 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64241604 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com