Provider Demographics
NPI:1679676548
Name:ALISON A. BOTEK, M.D., P.C.
Entity Type:Organization
Organization Name:ALISON A. BOTEK, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOTEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-748-7600
Mailing Address - Street 1:930 BELLEFONTE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-2754
Mailing Address - Country:US
Mailing Address - Phone:570-748-7600
Mailing Address - Fax:570-748-6900
Practice Address - Street 1:930 BELLEFONTE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-2754
Practice Address - Country:US
Practice Address - Phone:570-748-7600
Practice Address - Fax:570-748-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065413L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA079173Medicare ID - Type Unspecified