Basic Information
| Provider Information | |||||||||
| NPI: | 1821057423 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAUBE | ||||||||
| FirstName: | GRETA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BEITTEL | ||||||||
| OtherFirstName: | GRETA | ||||||||
| OtherMiddleName: | L | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2150 NOLL DRIVE, SUITE 100 | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172998933 | ||||||||
| FaxNumber: | 7172995635 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 NOLL DRIVE, SUITE 100 | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172998933 | ||||||||
| FaxNumber: | 7172995635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD419001 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 001899914 | 05 | PA | MEDICAID | 50033548 | 01 | PA | CAPITAL BLUE CROSS ID | OTHER | 1400579 | 01 | PW | HIGHMARK BLUESHIELD ID | OTHER |