Healthcare Provider Details

I. General information

NPI: 1669414611
Provider Name (Legal Business Name): NORTHERN LANCASTER COUNTY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ZIMMERMAN RD
LEOLA PA
17540-1949
US

IV. Provider business mailing address

PO BOX 398
BROWNSTOWN PA
17508-0398
US

V. Phone/Fax

Practice location:
  • Phone: 717-656-4922
  • Fax:
Mailing address:
  • Phone: 717-859-2038
  • Fax:

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: CYNTHIA MALIZIA
Title or Position: VP NLCMG
Credential:
Phone: 717-738-2280