Healthcare Provider Details

I. General information

NPI: 1558244939
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S CENTERVILLE RD
LANCASTER PA
17603-9733
US

IV. Provider business mailing address

555 N DUKE STREET - PO BOX 3555 ATTN: MELISSA PAULIN
LANCASTER PA
17604-3555
US

V. Phone/Fax

Practice location:
  • Phone: 175-440-1097
  • Fax: 717-544-0108
Mailing address:
  • Phone: 717-544-7279
  • Fax: 717-544-4296

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 Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY WELCH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 717-544-5658