Basic Information
| Provider Information | |||||||||
| NPI: | 1851956171 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEHIGH VALLEY PHYSICIAN GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 N CEDAR CREST BLVD STE 110B | ||||||||
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| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109731410 | ||||||||
| FaxNumber: | 6109731449 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 W FAIRMONT ST | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181043118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108412798 | ||||||||
| FaxNumber: | 6108412796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2019 | ||||||||
| LastUpdateDate: | 05/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | SANTIAGO | ||||||||
| AuthorizedOfficialFirstName: | BREANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER ENROLLMENT LIAISON | ||||||||
| AuthorizedOfficialTelephone: | 4848840661 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LEHIGH VALLEY PHYSICIAN GROUP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.