Basic Information
| Provider Information | |||||||||
| NPI: | 1194306647 | ||||||||
| 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 | ||||||||
| FaxNumber: | 8332136427 | ||||||||
| Practice Location | |||||||||
| Address1: | 5445 LANARK RD | ||||||||
| Address2: | |||||||||
| City: | CENTER VALLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180348694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845267300 | ||||||||
| FaxNumber: | 8664495832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2021 | ||||||||
| LastUpdateDate: | 04/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | CHIAVAROLI | ||||||||
| AuthorizedOfficialFirstName: | SUE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ENROLLMENT SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 4845263569 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST. LUKE'S PHYSICIAN GROUP, INC. | ||||||||
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| NPICertificationDate: | 04/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
No ID Information.