Healthcare Provider Details

I. General information

NPI: 1023003647
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ABBEYVILLE RD
LANCASTER PA
17603-4603
US

IV. Provider business mailing address

101 ABBEYVILLE RD
LANCASTER PA
17603-4603
US

V. Phone/Fax

Practice location:
  • Phone: 717-291-5991
  • Fax: 717-291-5806
Mailing address:
  • Phone: 717-291-5991
  • Fax: 717-291-5806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DENISE A KENNEDY
Title or Position: VP FINANCIAL SERVICES
Credential:
Phone: 717-544-5010