Healthcare Provider Details

I. General information

NPI: 1194063743
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 GOOD DR
LANCASTER PA
17601-2426
US

IV. Provider business mailing address

675 GOOD DR
LANCASTER PA
17601-2426
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3059
  • Fax: 717-394-7501
Mailing address:
  • Phone: 717-544-3059
  • Fax: 717-394-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic 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