Healthcare Provider Details

I. General information

NPI: 1457792897
Provider Name (Legal Business Name): LEHIGH PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6083 HAMILTON BLVD
WESCOSVILLE PA
18106-9767
US

IV. Provider business mailing address

1605 N CEDAR CREST BLVD SUITE 110B
ALLENTOWN PA
18104-2351
US

V. Phone/Fax

Practice location:
  • Phone: 610-841-4404
  • Fax: 610-395-9473
Mailing address:
  • Phone: 610-973-1410
  • Fax: 610-973-1449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD039542E
License Number StatePA

VIII. Authorized Official

Name: MR. THOMAS CALLAHAN
Title or Position: ASSOCIATE EXECUTIVE DIRECTOR OF FIN
Credential:
Phone: 610-798-4500