MEDICARE: LEHIGH VALLEY PHYSICIAN GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1790548808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEHIGH VALLEY PHYSICIAN GROUP

Provider Business Mailing Address
First Line	:	2100 MACK BLVD FL 4
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-5622
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	292 FRANTZ RD STE 102
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-6205
Country	:	US
Telephone Number	:	570-395-2502
Fax Number	:

Authorized Official
Title or Position	:	SR VP & CHIEF VALUE OFFICER
Name	:	JENNIFER STEPHENS
Credential	:
Telephone Number	:	484-862-3152

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	01/31/2025

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