Healthcare Provider Details
I. General information
NPI: 1740462134
Provider Name (Legal Business Name): LEHIGH VALLEY PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/28/2007
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1240 S CEDAR CREST BLVD SUITE 401
ALLENTOWN PA
18103-6369
US
IV. Provider business mailing address
PO BOX 783311
PHILADELPHIA PA
19178-3311
US
V. Phone/Fax
- Phone: 610-402-7880
- Fax:
- Phone: 484-884-4500
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0001X |
| Taxonomy | Radiation Oncology Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RH0003X |
| Taxonomy | Hematology & Oncology Physician |
| License Number | |
| License Number State | PA |
VIII. Authorized Official
Name:
JENNIFER
STEPHENS
Title or Position: SR VP & CHIEF VALUE OFFICER
Credential:
Phone: 484-862-3152