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NPI Code Detail

MEDICARE: DR. ELIZABETH ANNE LAVALLEY OTERSEN MD

MEDICARE: DR. ELIZABETH ANNE LAVALLEY OTERSEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician96220SC
2208000000XPediatrics PhysicianMD489169PA

General Provider Information

NPI Number : 1093455313
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH ANNE LAVALLEY OTERSEN MD
Provider Business Mailing Address
First Line : 100 N ACADEMY AVE
Second Line :
City : DANVILLE
State : PA
Zip : 17822-4903
Country : US
Telephone Number : 570-271-5600
Fax Number : 570-271-5851
Provider Business Practice Location Address
First Line : 103 THOMPSON ST STE 100
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-2543
Country : US
Telephone Number : 803-359-8855
Fax Number : 803-359-1257
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2022
Last Update Date : 04/06/2026

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