Healthcare Provider Details

I. General information

NPI: 1952086167
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/16/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 NEW HOLLAND AVE
LANCASTER PA
17601-5606
US

IV. Provider business mailing address

26 NORTH CEDAR STREET MELISSA PAULIN #2084
LITITZ PA
17543-1514
US

V. Phone/Fax

Practice location:
  • Phone: 717-397-8251
  • Fax: 717-399-4714
Mailing address:
  • Phone: 717-544-7279
  • Fax: 717-544-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE KENNEDY
Title or Position: VICE PRESIDENT FINANCIAL SERVICES
Credential:
Phone: 717-544-5010