1679577092 NPI number — ZORAYDA M LEE-LLACER M.D.

Table of content: ZORAYDA M LEE-LLACER M.D. (NPI 1679577092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679577092 NPI number — ZORAYDA M LEE-LLACER M.D.

Organization/Personal Information

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

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:
1679577092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8909 OLD BRANCH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-2528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-868-7274
Provider Business Mailing Address Fax Number:
301-868-9098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
818 BAYSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEVENSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21666-2734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-239-5888
Provider Business Practice Location Address Fax Number:
301-868-9098
Provider Enumeration Date:
06/13/2005

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: 207RC0200X , with the licence number:  D0012962 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: D0012962 , 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: 250371900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 66770001 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".




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