Basic Information
| Provider Information | |||||||||
| NPI: | 1669476628 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANCHEZ | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 COLUMBIA AVE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176034154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173972738 | ||||||||
| FaxNumber: | 7173977634 | ||||||||
| Practice Location | |||||||||
| Address1: | LANCASTER INTERNAL MEDICINE GROUP | ||||||||
| Address2: | 817 NORTH CHERRY STREET | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173938131 | ||||||||
| FaxNumber: | 7173939107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2005 | ||||||||
| LastUpdateDate: | 10/02/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 069410L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 60396 | 01 | PA | GEISINGER HEALTHPLAN PROV | OTHER | 0018124760001 | 05 | PA | MEDICAID | 2370818 | 01 | PA | AETNA US HEALTHCARE PROVI | OTHER | 623835 | 01 | PA | BLUE SHIELD PROVIDER # | OTHER | 9238956001 | 01 | PA | CIGNA PROVIDER NUMBER | OTHER | 01031401 | 01 | PA | CAPITAL BLUE CROSS PROV# | OTHER |