Basic Information
| Provider Information | |||||||||
| NPI: | 1376526152 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LANCASTER GENERAL MEDICAL GROUP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PENN MEDICINE LANCASTER GENERAL HEALTH PHYSICIANS HEMATOLOGY &ONCOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2102 HARRISBURG PIKE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175449400 | ||||||||
| FaxNumber: | 7175449401 | ||||||||
| Practice Location | |||||||||
| Address1: | 2102 HARRISBURG PIKE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175449400 | ||||||||
| FaxNumber: | 7175449401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2005 | ||||||||
| LastUpdateDate: | 11/16/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KENNEDY | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCIAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 7175445010 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 074040 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 03118200 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 1518637 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | 532458 | 01 | PA | AETNA HMO | OTHER | CE0357 | 01 | PA | RAILROAD MEDICARE | OTHER | 1007327490095 | 05 | PA | MEDICAID | 4336 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 4523106 | 01 | PA | AETNA NON-HMO | OTHER |