Healthcare Provider Details

I. General information

NPI: 1427040070
Provider Name (Legal Business Name): JOHN M. LEHIGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N MAIN ST
UNION BRIDGE MD
21791-9102
US

IV. Provider business mailing address

PO BOX 37086
BALTIMORE MD
21297-3086
US

V. Phone/Fax

Practice location:
  • Phone: 410-775-2622
  • Fax: 410-775-2050
Mailing address:
  • Phone: 410-775-2622
  • Fax: 410-775-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0020330
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: