Provider Demographics
NPI:1861685745
Name:PAUL A. LOTKE M.D., P.C.
Entity Type:Organization
Organization Name:PAUL A. LOTKE M.D., P.C.
Other - Org Name:PAUL A. LOTKE M.D., PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHOPAEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOTKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-449-0970
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029079L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
064082Medicare UPIN