Healthcare Provider Details

I. General information

NPI: 1801612056
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2185 OREGON PIKE
LANCASTER PA
17601-4604
US

IV. Provider business mailing address

26 N CEDAR STREET 2ND FL 2084
LITITZ PA
17543
US

V. Phone/Fax

Practice location:
  • Phone: 717-394-4342
  • Fax:
Mailing address:
  • Phone: 717-544-7279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE KENNEDY
Title or Position: VICE PRESIDENT OPERATIONAL FIN
Credential:
Phone: 717-544-5010