Healthcare Provider Details

I. General information

NPI: 1235628660
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 E MAIN ST
LEOLA PA
17540-1964
US

IV. Provider business mailing address

1030 NEW HOLLAND AVE BLDG 12A SUITE 200
LANCASTER PA
17601-5690
US

V. Phone/Fax

Practice location:
  • Phone: 717-656-2141
  • Fax: 717-656-4986
Mailing address:
  • Phone: 717-544-5028
  • Fax: 717-544-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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