Provider Demographics
NPI:1750484739
Name:BOTEK, ALISON A (MD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:A
Last Name:BOTEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 BELLEFONTE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-2754
Mailing Address - Country:US
Mailing Address - Phone:570-748-7600
Mailing Address - Fax:570-748-6900
Practice Address - Street 1:930 BELLEFONTE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-2754
Practice Address - Country:US
Practice Address - Phone:570-748-7600
Practice Address - Fax:570-748-6900
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065413L207N00000X
PAMD-065413-L207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH19287Medicare UPIN