Healthcare Provider Details

I. General information

NPI: 1467166488
Provider Name (Legal Business Name): LANCASTER PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W JAMES ST STE 103A
LANCASTER PA
17603-2979
US

IV. Provider business mailing address

315 W JAMES ST STE 103A
LANCASTER PA
17603-2979
US

V. Phone/Fax

Practice location:
  • Phone: 717-869-6710
  • Fax: 717-326-1395
Mailing address:
  • Phone: 717-869-6710
  • Fax: 717-326-1395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TITUS LEITORO
Title or Position: PARTNER
Credential: NP
Phone: 717-869-6710