Provider Demographics
NPI:1649208117
Name:LOTKE, PAUL A (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:LOTKE
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 1:510 DARBY RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4630
Mailing Address - Country:US
Mailing Address - Phone:610-449-0970
Mailing Address - Fax:610-449-9814
Practice Address - Street 1:510 DARBY RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4630
Practice Address - Country:US
Practice Address - Phone:610-449-0970
Practice Address - Fax:610-449-9814
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029079L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2299415000OtherINDEP. B/C
PA0055125OtherAETNA
B34695Medicare UPIN
PA2299415000OtherINDEP. B/C