Basic Information
| Provider Information | |||||||||
| NPI: | 1811131402 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEHIGH VALLEY PHYSICIAN GROUP | ||||||||
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| OtherOrganizationName: | EAST PENN MEDICAL PRACTICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 N CEDAR CREST BLVD | ||||||||
| Address2: | SUITE 110B | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109731410 | ||||||||
| FaxNumber: | 6109731449 | ||||||||
| Practice Location | |||||||||
| Address1: | 723 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | EMMAUS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180492017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109674830 | ||||||||
| FaxNumber: | 6109657737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2009 | ||||||||
| LastUpdateDate: | 10/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | CALLAHAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSOCIATE EXECUTIVE DIRECTOR OF FIN | ||||||||
| AuthorizedOfficialTelephone: | 6107984500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LEHIGH VALLEY PHYSICIAN GROUP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.