Healthcare Provider Details

I. General information

NPI: 1699736447
Provider Name (Legal Business Name): LEBANON OB GYN ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 CORNWALL RD
LEBANON PA
17042-7089
US

IV. Provider business mailing address

618 CORNWALL RD
LEBANON PA
17042-7089
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-8147
  • Fax: 717-273-8907
Mailing address:
  • Phone: 717-273-8147
  • Fax: 717-273-8907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD034485L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD028832E
License Number StatePA

VIII. Authorized Official

Name: DR. CHANG W OH
Title or Position: DOCTOR
Credential: MD
Phone: 717-273-8147