Healthcare Provider Details

I. General information

NPI: 1447698576
Provider Name (Legal Business Name): LANCASTER GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CORNERSTONE DR SUITE B
MOUNT JOY PA
17552-9416
US

IV. Provider business mailing address

1001 CORNERSTONE DR SUITE B
MOUNT JOY PA
17552-9416
US

V. Phone/Fax

Practice location:
  • Phone: 717-653-2929
  • Fax: 717-492-0699
Mailing address:
  • Phone: 717-653-2929
  • Fax: 717-492-0699

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