Healthcare Provider Details

I. General information

NPI: 1881925931
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 SPRING VALLEY RD
LANCASTER PA
17601-2427
US

IV. Provider business mailing address

2118 SPRING VALLEY RD
LANCASTER PA
17601-2427
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-0150
  • Fax: 717-544-0151
Mailing address:
  • Phone: 717-544-0150
  • Fax: 717-544-0151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DENISE KENNEDY
Title or Position: VICE PRESIDENT FINANCIAL SERVICES
Credential:
Phone: 717-544-5010