Healthcare Provider Details

I. General information

NPI: 1922073865
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 PETERS RD STE 202
LITITZ PA
17543-7685
US

IV. Provider business mailing address

51 PETERS RD STE 202
LITITZ PA
17543-7685
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-6481
  • Fax: 717-569-5213
Mailing address:
  • Phone: 717-569-6481
  • Fax: 717-569-5213

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:

# 1
Identifier1001184
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAMERIHEALTH MERCY
# 2
Identifier51203
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA HMO
# 3
Identifier5803
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA CAP OFFICE#
# 4
Identifier874348
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD
# 5
IdentifierS1BX
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGEISINGER HEALTH PLAN
# 6
Identifier4482843
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA NON-HMO
# 7
Identifier1007327490226
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 8
Identifier02404600
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAPITAL BLUE CROSS
# 9
Identifier1508046
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGATEWAY HEALTH PLAN

VIII. Authorized Official

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