Provider Demographics
NPI:1700863966
Name:HANSROTE, LOUIS W (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:W
Last Name:HANSROTE
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 1:401 N 17TH ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5034
Mailing Address - Country:US
Mailing Address - Phone:610-437-6687
Mailing Address - Fax:610-437-5232
Practice Address - Street 1:401 N 17TH ST
Practice Address - Street 2:SUITE 309
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5034
Practice Address - Country:US
Practice Address - Phone:610-437-6687
Practice Address - Fax:610-437-5232
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044074-L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012494190001Medicaid
PAG23930Medicare UPIN
PAHA672576Medicare ID - Type Unspecified