Healthcare Provider Details

I. General information

NPI: 1275510406
Provider Name (Legal Business Name): LEBANON CARDIOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 NORMAN DRIVE
LEBANON PA
17042
US

IV. Provider business mailing address

775 NORMAN DRIVE
LEBANON PA
17042
US

V. Phone/Fax

Practice location:
  • Phone: 717-274-5500
  • Fax: 717-202-0330
Mailing address:
  • Phone: 717-274-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS M CLEMENS
Title or Position: PRESIDENT
Credential: MD
Phone: 717-274-5500