Healthcare Provider Details

I. General information

NPI: 1932692795
Provider Name (Legal Business Name): LEHIGH VALLEY PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2588 STATE ROUTE 903
ALBRIGHTSVILLE PA
18210
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 570-722-2125
  • Fax: 570-215-4338
Mailing address:
  • Phone: 484-884-4500
  • Fax: 484-884-0699

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: BREANNA SANTIAGO
Title or Position: ENROLLMENT SPECIALIST
Credential:
Phone: 484-884-0661