Provider Demographics
NPI:1558499467
Name:STOTZ, LORI GREEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:GREEN
Last Name:STOTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6054 S STATE ROUTE 48
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8280
Mailing Address - Country:US
Mailing Address - Phone:513-981-5760
Mailing Address - Fax:513-981-5769
Practice Address - Street 1:6054 S STATE ROUTE 48
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-8280
Practice Address - Country:US
Practice Address - Phone:513-981-5760
Practice Address - Fax:513-981-5769
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH 35078232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH086720OtherMEDICARE NUMBER
9312731OtherGROUP MEDICARE NUMBER
1740337765OtherGROUP NPI NUMBER
OH1558499467OtherINDIVIDUAL NPI NUMBER