Healthcare Provider Details

I. General information

NPI: 1235460387
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 LITITZ PIKE
LITITZ PA
17543-9328
US

IV. Provider business mailing address

1008 LITITZ PIKE
LITITZ PA
17543-9328
US

V. Phone/Fax

Practice location:
  • Phone: 717-627-6074
  • Fax: 717-627-6915
Mailing address:
  • Phone: 717-627-6074
  • Fax: 717-627-6915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
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: DR. KENT E CARR
Title or Position: SR. VP, PHYSICIAN SERVICES
Credential: MD
Phone: 717-544-4001