Healthcare Provider Details

I. General information

NPI: 1790251973
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 CROOKED OAK DR
LANCASTER PA
17601-4269
US

IV. Provider business mailing address

1030 NEW HOLLAND AVE
LANCASTER PA
17601-5690
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-5331
  • Fax: 717-569-4210
Mailing address:
  • Phone: 717-544-7279
  • Fax: 717-544-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DENISE KENNEDY
Title or Position: VP, FINANCIAL SERVICES
Credential:
Phone: 717-544-5010