Provider Demographics
NPI:1518050327
Name:OTHMER, JOHANN PHILIPP (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHANN
Middle Name:PHILIPP
Last Name:OTHMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J. PHILIPP
Other - Middle Name:
Other - Last Name:OTHMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:802 NEW HOLLAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2288
Mailing Address - Country:US
Mailing Address - Phone:717-560-3782
Mailing Address - Fax:717-560-3787
Practice Address - Street 1:802 NEW HOLLAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2288
Practice Address - Country:US
Practice Address - Phone:717-560-3782
Practice Address - Fax:717-560-3787
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063511L2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA040270OtherMEDICARE PIN
PAMD063511LOtherMEDICAL LICENSE
PA0018120820003Medicaid
PA040270Medicare PIN