Healthcare Provider Details

I. General information

NPI: 1063463701
Provider Name (Legal Business Name): ST. LUKE'S PHYSICIAN GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 BUSHKILL PLAZA LN
WIND GAP PA
18091-9665
US

IV. Provider business mailing address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 610-863-7020
  • Fax: 866-833-9399
Mailing address:
  • Phone: 610-863-7020
  • Fax: 866-833-9399

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: MS. SUSAN CHIAVAROLI
Title or Position: MANAGER
Credential:
Phone: 484-526-3569