Healthcare Provider Details

I. General information

NPI: 1427502582
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2016
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 PETERS RD
LITITZ PA
17543-7685
US

IV. Provider business mailing address

51 PETERS RD
LITITZ PA
17543-7685
US

V. Phone/Fax

Practice location:
  • Phone: 717-626-2167
  • Fax: 717-626-1915
Mailing address:
  • Phone: 717-626-2167
  • Fax: 717-626-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family 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