Basic Information
| Provider Information | |||||||||
| NPI: | 1174512230 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAUTER | ||||||||
| FirstName: | OTTO | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N DUKE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175448144 | ||||||||
| FaxNumber: | 7175448140 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 N DUKE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175448144 | ||||||||
| FaxNumber: | 7175448140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 08/03/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD033013E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01540002 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 1519248 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | 17846 S1QA | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 5900075 | 01 | PA | AETNA NON-HMO | OTHER | 110145783 | 01 | PA | RAILROAD MEDICARE | OTHER | P002538 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | 0010019420003 | 05 | PA | MEDICAID | 098957 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 563495 | 01 | PA | AETNA HMO | OTHER | B36337 | 01 | PA | HEALTH ASSURANCE | OTHER |