Healthcare Provider Details

I. General information

NPI: 1295819084
Provider Name (Legal Business Name): REGIONAL GASTROENTEROLOGY ASSOCIATES OF LANCASTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 HARRISBURG PIKE STE 300
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

2104 HARRISBURG PIKE STE. 300 PO BOX 3200
LANCASTER PA
17604-3200
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3400
  • Fax: 717-544-3408
Mailing address:
  • Phone: 717-544-3400
  • Fax: 717-544-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number15891501
License Number StatePA

VIII. Authorized Official

Name: DALE WHITEBLOOM
Title or Position: PRESIDENT
Credential: DO
Phone: 717-544-3400