Healthcare Provider Details

I. General information

NPI: 1992743900
Provider Name (Legal Business Name): NORTHERN LANCASTER COUNTY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S 7TH ST
AKRON PA
17501-1329
US

IV. Provider business mailing address

4131 OREGON PIKE SUITE C
EPHRATA PA
17522-9550
US

V. Phone/Fax

Practice location:
  • Phone: 717-859-2112
  • Fax:
Mailing address:
  • Phone: 717-859-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES DAVID NOLL
Title or Position: VICE PRESIDENT
Credential: DO
Phone: 717-859-5161