Healthcare Provider Details

I. General information

NPI: 1588043376
Provider Name (Legal Business Name): ST. LUKE'S PHYSICIAN GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N 3RD ST 2ND FLOOR
EASTON PA
18042-1869
US

IV. Provider business mailing address

100 N 3RD ST 2ND FLOOR
EASTON PA
18042-1869
US

V. Phone/Fax

Practice location:
  • Phone: 484-503-8010
  • Fax: 484-503-8009
Mailing address:
  • Phone: 484-503-8010
  • Fax: 484-503-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DEAN W. EVANS
Title or Position: PRESIDENT
Credential:
Phone: 484-526-4991