Healthcare Provider Details

I. General information

NPI: 1255305207
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF LANCASTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 10/30/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1554 WESLEY WAY
LANCASTER OH
43130
US

IV. Provider business mailing address

1554 WESLEY WAY
LANCASTER OH
43130
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-6386
  • Fax: 740-687-1388
Mailing address:
  • Phone: 740-687-6386
  • Fax: 740-687-1388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER L MILLER
Title or Position: PRESIDENT
Credential: MD
Phone: 740-687-6386