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General NPI Number Information
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NPI Number | 1184888778
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Entity Type | Organization
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Legal Business Name | NORTHERN LANCASTER COUNTY MEDICAL GROUP
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 10/15/2015
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Provider Practice Location Address
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Address Line | 264 GRANITE RUN DR
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City | LANCASTER
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State | PA
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Zip | 17601-6804
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Country | US
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Telephone | 717-721-8205
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Fax | 717-721-8251
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Provider Business Mailing Address
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Address Line | 264 GRANITE RUN DR
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City | LANCASTER
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State | PA
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Zip | 17601-6804
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Country | US
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Telephone | 717-721-8205
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Fax | 717-721-8251
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CHARLES DAVID NOLL
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Credential | DO
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Telephone | 717-859-5161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD032838L
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License Number State | PA
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