Healthcare Provider Details

I. General information

NPI: 1730463654
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 GOOD DR SUITE 23
LANCASTER PA
17601-2433
US

IV. Provider business mailing address

694 GOOD DR SUITE 23
LANCASTER PA
17601-2433
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-0375
  • Fax: 717-544-0376
Mailing address:
  • Phone: 717-544-0375
  • Fax: 717-544-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANK JOSEPH BYORICK III
Title or Position: SR. VP, CFO
Credential:
Phone: 717-544-4296