Provider Demographics
NPI:1144369919
Name:GAETANO, LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:GAETANO
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 1:1803 MT. ROSE AVENUE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3051
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:2007-02-06
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03927400207R00000X
PAMD061027L207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
110213996OtherRAILROAD MEDICARE
PA102219829Medicaid
PA165975OtherHIGHMARK BLUE SHIELD
PA225710OtherJOHNS HOPKINS
PA5542322OtherAETNA
PA256002OtherUNISON-WMG
MD945950OtherCAREFIRST MD BCBS
PA20090431OtherAMERIHEALTH MERCY-WMG
PA50086656OtherCAPITAL BLUE CROSS
MD039157300Medicaid
PA118218OtherGEISINGER HEALTH PLAN
PA1577542OtherGATEWAY
PAP00691881Medicare PIN
PA140163FLTMedicare PIN
PA50086656OtherCAPITAL BLUE CROSS
C57082Medicare UPIN