Healthcare Provider Details

I. General information

NPI: 1538461850
Provider Name (Legal Business Name): ST. LUKE'S PHYSICIAN GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 WALBERT AVE STE 102
ALLENTOWN PA
18104-6042
US

IV. Provider business mailing address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 610-628-8700
  • Fax: 833-816-7520
Mailing address:
  • Phone: 610-437-3934
  • Fax: 833-816-7520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SCOTT WOLFE
Title or Position: PRESIDENT
Credential:
Phone: 484-526-4911