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:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:
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:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417812208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03273901OtherCAPITAL BLUE CROSS-WMG
PA7230504OtherAETNA
PA15820035OtherGATEWAY
PA20016270OtherAH MERCY-WMG FLR 4 MKB
PA001893590Medicaid
PA1386394OtherHIGHMARK BLUE SHIELD
PA157419OtherUNISON-WMG
PA20015726OtherAH MERCY-WMG COLONIAL AVE
PA30131970OtherAMERIHEALTH MERCY - WMG
PA104588OtherJOHNS HOPKINS
PA2161248OtherMAMSI-WMG
PA50371OtherGEISINGER
MD616511OtherCAREFIRST MD BCBS
PA30131970OtherAMERIHEALTH MERCY - WMG
PA15820035OtherGATEWAY
PA2161248OtherMAMSI-WMG
PA110237119Medicare PIN