Healthcare Provider Details

I. General information

NPI: 1003995960
Provider Name (Legal Business Name): NORTHERN LANCASTER COUNTY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGHLANDS DR SUITE 204
LITITZ PA
17543-7693
US

IV. Provider business mailing address

PO BOX 398
BROWNSTOWN PA
17508-0398
US

V. Phone/Fax

Practice location:
  • Phone: 717-626-5437
  • Fax:
Mailing address:
  • Phone: 717-859-2038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. CYNTHIA MALIZIA
Title or Position: VICE-PRESIDENT
Credential:
Phone: 717-738-2280