Healthcare Provider Details

I. General information

NPI: 1518050327
Provider Name (Legal Business Name): JOHANN PHILIPP OTHMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: J. PHILIPP OTHMER M.D.

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 NEW HOLLAND AVE STE 100
LANCASTER PA
17602-2288
US

IV. Provider business mailing address

802 NEW HOLLAND AVE STE 100
LANCASTER PA
17602-2288
US

V. Phone/Fax

Practice location:
  • Phone: 717-560-3782
  • Fax: 717-560-3787
Mailing address:
  • Phone: 717-560-3782
  • Fax: 717-560-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD063511L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD063511L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: