Basic Information
| Provider Information | |||||||||
| NPI: | 1598740508 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LANCASTER ORTHOPEDIC GROUP PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 GRANITE RUN DR | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176016823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175604200 | ||||||||
| FaxNumber: | 7175606380 | ||||||||
| Practice Location | |||||||||
| Address1: | 231 GRANITE RUN DR | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176016823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175604200 | ||||||||
| FaxNumber: | 7175606380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 05/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | CONRAD | ||||||||
| AuthorizedOfficialFirstName: | WAYNE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT EXECUTIVE COMMITTEE | ||||||||
| AuthorizedOfficialTelephone: | 7175604200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 411676 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | CN5002 | 01 | PA | RAILROAD MEDICARE | OTHER | 02368200 | 01 | PA | CAPITAL BLUE CROSS | OTHER |