Basic Information
| Provider Information | |||||||||
| NPI: | 1790399533 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LANCASTER GENERAL MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1030 NEW HOLLAND AVENUE | ||||||||
| Address2: | BLDG 12A STE 200 MELISSA PAULIN | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176015690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175447279 | ||||||||
| FaxNumber: | 7175444296 | ||||||||
| Practice Location | |||||||||
| Address1: | 554 N DUKE ST FL 3 | ||||||||
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| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175441427 | ||||||||
| FaxNumber: | 7175447771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2020 | ||||||||
| LastUpdateDate: | 08/31/2020 | ||||||||
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| AuthorizedOfficialLastName: | KENNEDY | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PATIENT FINANCIAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 7175445010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0401X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine |
No ID Information.