Healthcare Provider Details

I. General information

NPI: 1417009291
Provider Name (Legal Business Name): LEBANON INTERNAL MEDICINE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 NORMAN DR
LEBANON PA
17042-7497
US

IV. Provider business mailing address

755 NORMAN DR
LEBANON PA
17042-7497
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-6706
  • Fax: 717-273-1435
Mailing address:
  • Phone: 717-273-6706
  • Fax: 717-273-1435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number000438
License Number StatePA

VIII. Authorized Official

Name: ANDREA L SIANIS
Title or Position: BILLING MANAGER
Credential:
Phone: 717-273-6706