Healthcare Provider Details

I. General information

NPI: 1790158236
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

Provider Other Name: PENN MEDICINE LANCASTER GENERAL HEALTH PHYSICIANS NEUROLOGY

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N DUKE ST NEUROSCIENCE SERVICE LINE ADMINISTRATION
LANCASTER PA
17602-2250
US

IV. Provider business mailing address

555 N DUKE ST NEUROSCIENCE SERVICE LINE ADMINISTRATION
LANCASTER PA
17602-2250
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-5008
  • Fax: 717-544-5041
Mailing address:
  • Phone: 717-544-5008
  • Fax: 717-544-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

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