Basic Information
| Provider Information | |||||||||
| NPI: | 1912040627 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOTAY-LEHMER | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 213 | ||||||||
| Address2: | |||||||||
| City: | CHURCHVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210280213 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 BIDDLE AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197023967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028367820 | ||||||||
| FaxNumber: | 3028367826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 09/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | C2-0012895 | DE | N | Allopathic & Osteopathic Physicians | General Practice | 208000000X | H0069465 | MD | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 5700418 | 05 | MD | MEDICAID |