Healthcare Provider Details

I. General information

NPI: 1790340586
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 GOOD DR FL 2
LANCASTER PA
17601-2433
US

IV. Provider business mailing address

555 N DUKE STREET PO BOX 3555
LANCASTER PA
17604-3555
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-0700
  • Fax: 717-544-0709
Mailing address:
  • Phone: 717-544-7279
  • Fax: 717-544-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY WELCH
Title or Position: CHIEF FINANCIAL OFC
Credential:
Phone: 717-544-5658