Healthcare Provider Details

I. General information

NPI: 1811808728
Provider Name (Legal Business Name): DR. MAG DIRECT PRIMARY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N POINTE BLVD STE 106
LANCASTER PA
17601-4134
US

IV. Provider business mailing address

652 OAKWOOD LN
LANCASTER PA
17603-2451
US

V. Phone/Fax

Practice location:
  • Phone: 717-500-3930
  • Fax:
Mailing address:
  • Phone: 713-410-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. EFREM BOLANO MAGTAGNOB
Title or Position: FOUNDER/CEO
Credential: MD
Phone: 713-410-8087