Provider Demographics
NPI:1821057423
Name:LAUBE, GRETA L (MD)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:L
Last Name:LAUBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRETA
Other - Middle Name:L
Other - Last Name:BEITTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2150 NOLL DRIVE, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603
Mailing Address - Country:US
Mailing Address - Phone:717-299-8933
Mailing Address - Fax:717-299-5635
Practice Address - Street 1:2150 NOLL DRIVE, SUITE 100
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603
Practice Address - Country:US
Practice Address - Phone:717-299-8933
Practice Address - Fax:717-299-5635
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419001208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001899914Medicaid
PA50033548OtherCAPITAL BLUE CROSS ID
PW1400579OtherHIGHMARK BLUESHIELD ID