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NPI Code Detail

MEDICARE: DR. JOHANN PHILIPP OTHMER M.D.

MEDICARE: DR. JOHANN PHILIPP OTHMER M.D.
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
12084P0800XPsychiatry PhysicianMD063511LPA
22084P0804XChild & Adolescent Psychiatry PhysicianMD063511LPA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1040270OTHERPAMEDICARE PIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MD063511LOTHERPAMEDICAL LICENSE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518050327
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHANN PHILIPP OTHMER M.D.
Provider Business Mailing Address
First Line : 802 NEW HOLLAND AVE STE 100
Second Line :
City : LANCASTER
State : PA
Zip : 17602-2288
Country : US
Telephone Number : 717-560-3782
Fax Number : 717-560-3787
Provider Business Practice Location Address
First Line : 802 NEW HOLLAND AVE STE 100
Second Line :
City : LANCASTER
State : PA
Zip : 17602-2288
Country : US
Telephone Number : 717-560-3782
Fax Number : 717-560-3787
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 11/15/2019

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