Healthcare Provider Details

I. General information

NPI: 1831810753
Provider Name (Legal Business Name): LEHIGH VALLEY PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 ROUTE 209 STE 103
GILBERT PA
18331-7751
US

IV. Provider business mailing address

1605 N CEDAR CREST BLVD STE 110B
ALLENTOWN PA
18104-2351
US

V. Phone/Fax

Practice location:
  • Phone: 610-951-4500
  • Fax: 610-951-4600
Mailing address:
  • Phone: 484-330-1377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CALLAHAN
Title or Position: ASSOCIATE EXECUTIVE DIRECTOR OF FIN
Credential:
Phone: 610-798-4500