Provider Demographics
NPI:1174512230
Name:LAUTER, OTTO SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:OTTO
Middle Name:SCOTT
Last Name:LAUTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-8144
Mailing Address - Fax:717-544-8140
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-8144
Practice Address - Fax:717-544-8140
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033013E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01540002OtherCAPITAL BLUE CROSS
PA1519248OtherGATEWAY HEALTH PLAN
PA17846 S1QAOtherGEISINGER HEALTH PLAN
PA5900075OtherAETNA NON-HMO
PA110145783OtherRAILROAD MEDICARE
PAP002538OtherGATEWAY HEALTH PLAN
PA0010019420003Medicaid
PA098957OtherHIGHMARK BLUE SHIELD
PA563495OtherAETNA HMO
PAB36337OtherHEALTH ASSURANCE
PAP002538OtherGATEWAY HEALTH PLAN
PAB36337Medicare UPIN