Healthcare Provider Details

I. General information

NPI: 1174620520
Provider Name (Legal Business Name): LANCASTER ONE MEDICAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 HWY 9 BYPASS E
LANCASTER SC
29720
US

IV. Provider business mailing address

539 HWY 9 BYPASS E
LANCASTER SC
29720
US

V. Phone/Fax

Practice location:
  • Phone: 803-286-5700
  • Fax: 803-285-6119
Mailing address:
  • Phone: 803-286-5700
  • Fax: 803-285-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number8904
License Number StateSC

VIII. Authorized Official

Name: MRS. XIAOLU J DONG
Title or Position: OWNER PHYSICIAN
Credential: DC
Phone: 803-286-5700