Healthcare Provider Details

I. General information

NPI: 1487039699
Provider Name (Legal Business Name): LANCASTER MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N ARCH ST
LANCASTER PA
17603-2929
US

IV. Provider business mailing address

330 N ARCH ST
LANCASTER PA
17603-2929
US

V. Phone/Fax

Practice location:
  • Phone: 717-735-7422
  • Fax:
Mailing address:
  • Phone: 717-735-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DENNIS HERTZ
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 717-291-8078