Healthcare Provider Details

I. General information

NPI: 1134100985
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2108 HARRISBURG PIKE SUITE 200
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

2108 HARRISBURG PIKE SUITE 200
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-299-1301
  • Fax: 717-299-2214
Mailing address:
  • Phone: 717-299-1301
  • Fax: 717-299-2214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

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