Healthcare Provider Details

I. General information

NPI: 1194306647
Provider Name (Legal Business Name): ST. LUKE'S PHYSICIAN GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 LANARK RD
CENTER VALLEY PA
18034-8694
US

IV. Provider business mailing address

77 S COMMERCE WAY
BETHLEHEM PA
18017-8891
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-7300
  • Fax: 866-449-5832
Mailing address:
  • Phone: 484-526-4999
  • Fax: 833-213-6427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUE CHIAVAROLI
Title or Position: ENROLLMENT SUPERVISOR
Credential:
Phone: 484-526-3569