Healthcare Provider Details

I. General information

NPI: 1174257513
Provider Name (Legal Business Name): LEHIGH VALLEY PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 MAIN ST STE 220
DICKSON CITY PA
18519-1668
US

IV. Provider business mailing address

334 MAIN ST STE 220
DICKSON CITY PA
18519-1668
US

V. Phone/Fax

Practice location:
  • Phone: 570-307-4191
  • Fax: 570-307-4195
Mailing address:
  • Phone: 570-307-4191
  • Fax: 570-307-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JAMES DEMOPOULOS
Title or Position: SR VP & COO
Credential:
Phone: 484-862-3333