Provider Demographics
NPI:1285680322
Name:LAUTERBACH, MARGO D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGO
Middle Name:D
Last Name:LAUTERBACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6501 N CHARLES ST
Mailing Address - Street 2:P.O. BOX 6815
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6819
Mailing Address - Country:US
Mailing Address - Phone:410-938-4748
Mailing Address - Fax:410-938-5310
Practice Address - Street 1:6501 N CHARLES ST
Practice Address - Street 2:GIBSON BUILDING SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6819
Practice Address - Country:US
Practice Address - Phone:410-938-4748
Practice Address - Fax:410-938-5310
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD672362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD415468100Medicaid
MD128636YRMMedicare PIN
MD415468100Medicaid