Provider Demographics
NPI:1972532513
Name:MOTTER, LEO JUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:JUSTIN
Last Name:MOTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-812-2495
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-4005
Practice Address - Fax:717-812-2495
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417812207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50371OtherGEISINGER
PA7230504OtherAETNA
PA03273901OtherCAPITAL BLUE CROSS-WMG
PA30131970OtherAMERIHEALTH MERCY - WMG
PA157419OtherUNISON-WMG
PA1386394OtherHIGHMARK BLUE SHIELD
PA15820035OtherGATEWAY
PA20015726OtherAH MERCY-WMG COLONIAL AVE
PA20016270OtherAH MERCY-WMG FLR 4 MKB
MD616511OtherCAREFIRST MD BCBS
PA001893590Medicaid
PA2161248OtherMAMSI-WMG
PA104588OtherJOHNS HOPKINS
PA30131970OtherAMERIHEALTH MERCY - WMG
PA15820035OtherGATEWAY
PA2161248OtherMAMSI-WMG
PA110237119Medicare PIN