Provider Demographics
NPI:1942220983
Name:ROTHERMEL, LORI KAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:KAYE
Last Name:ROTHERMEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR STE 306
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9350
Practice Address - Country:US
Practice Address - Phone:570-522-2640
Practice Address - Fax:570-768-3921
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420910207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1491702OtherBLUE SHIELD
PA232809429OtherTRICARE
PA50010262OtherCAPITAL BLUE CROSS
PA321845OtherHEALTH AMERICA
PAP00011134OtherRAILROAD MEDICARE
PA19476280001Medicaid
PAH81871Medicare UPIN