Basic Information
| Provider Information | |||||||||
| NPI: | 1063003598 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. LUKE'S PHYSICIAN GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 S COMMERCE WAY | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180178891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845264999 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2571 BAGLYOS CIR STE B29 | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180208050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845030235 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2021 | ||||||||
| LastUpdateDate: | 01/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | CHIAVAROLI | ||||||||
| AuthorizedOfficialFirstName: | SUE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ENROLLMENT SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 4845263569 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST. LUKE'S PHYSICIAN GROUP, INC. | ||||||||
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| NPICertificationDate: | 01/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0201X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology |
No ID Information.