| Martin Leboutillier Iii, MD | |
|
Fourth & Walnut Sts, 2nd Fl, Lebanon, PA 17042-1281 | |
| (717) 270-3751 | |
| (717) 270-3754 |
| Full Name | Martin Leboutillier Iii |
|---|---|
| Gender | Male |
| Speciality | Thoracic Surgery |
| Experience | 35 Years |
| Location | Fourth & Walnut Sts, Lebanon, Pennsylvania |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831152651 | NPI | - | NPPES |
| 058255700 | Medicaid | MD | |
| 001708549 | Medicaid | PA | |
| 30139141 | Other | PA | AMERIHEALTH MERCY-WMG |
| 976216 | Other | PA | HIGHMARK BLUE SHIELD |
| 1511587 | Other | PA | GATEWAY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208G00000X | Thoracic Surgery (cardiothoracic Vascular Surgery) | MD065743L (Pennsylvania) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Good Samaritan Hospital | Lebanon, PA | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Wellspan Medical Group | 1951213115 | 2052 |
| Entity Name | Wellspan Medical Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1669770004 PECOS PAC ID: 1951213115 Enrollment ID: O20040220000815 |
| Mailing Address | Practice Location Address |
|---|---|
| Martin Leboutillier Iii, MD Fourth & Walnut Sts, 2nd Fl, Lebanon, PA 17042-1281 Ph: (717) 270-3751 | Martin Leboutillier Iii, MD Fourth & Walnut Sts, 2nd Fl, Lebanon, PA 17042-1281 Ph: (717) 270-3751 |
Savas Mavridis, MD Thoracic Surgery (Cardiothoracic Vascular Surgery) Medicare: Accepting Medicare Assignments Practice Location: 252 S 4th St Fl 2, Lebanon, PA 17042 Phone: 717-270-3751 Fax: 717-270-3751 | |
Dr. Mohammad Bashar Yousuf, M.D. Thoracic Surgery (Cardiothoracic Vascular Surgery) Medicare: Not Enrolled in Medicare Practice Location: 252 S 4th St Fl 2, Lebanon, PA 17042 Phone: 717-270-3751 Fax: 717-270-3754 | |
Dr. David John Cohen, MD Thoracic Surgery (Cardiothoracic Vascular Surgery) Medicare: Accepting Medicare Assignments Practice Location: 252 S 4th St Fl 2, Lebanon, PA 17042 Phone: 717-270-3751 Fax: 717-270-3754 |