Healthcare Provider Details

I. General information

NPI: 1790793149
Provider Name (Legal Business Name): ST. LUKE'S PHYSICIAN GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ST LUKES BLVD
EASTON PA
18045-5671
US

IV. Provider business mailing address

1600 ST LUKES BLVD
EASTON PA
18045-5671
US

V. Phone/Fax

Practice location:
  • Phone: 484-503-4500
  • Fax: 484-503-4501
Mailing address:
  • Phone: 484-503-4500
  • Fax: 484-503-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

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