Individual
MARTIN LEBOUTILLIER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
FOURTH & WALNUT STS, 2ND FL, LEBANON, PA 17042-1281
(717) 270-3751
(717) 270-3754
Mailing address
FOURTH & WALNUT STS, 2ND FL, LEBANON, PA 17042-1281
(717) 270-3751
(717) 270-3754
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
MD065743L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001708549
—
PA
05
—
058255700
—
MD
01
—
1511587
GATEWAY
PA
01
—
30139141
AMERIHEALTH MERCY-WMG
PA
01
—
976216
HIGHMARK BLUE SHIELD
PA
Enumeration date
04/11/2006
Last updated
07/20/2016
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