Basic Information
| Provider Information | |||||||||
| NPI: | 1144369919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAETANO | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 MT. ROSE AVENUE | ||||||||
| Address2: | SUITE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178122495 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 S GEORGE ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178514005 | ||||||||
| FaxNumber: | 7178122495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 06/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA03927400 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD061027L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD061027L | PA | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 110213996 | 01 | RAILROAD MEDICARE | OTHER | 102219829 | 05 | PA | MEDICAID | 165975 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 225710 | 01 | PA | JOHNS HOPKINS | OTHER | 5542322 | 01 | PA | AETNA | OTHER | 256002 | 01 | PA | UNISON-WMG | OTHER | 945950 | 01 | MD | CAREFIRST MD BCBS | OTHER | 20090431 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 50086656 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 039157300 | 05 | MD | MEDICAID | 118218 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 1577542 | 01 | PA | GATEWAY | OTHER |