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General NPI Number Information
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NPI Number | 1811808728
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Entity Type | Organization
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Legal Business Name | DR. MAG DIRECT PRIMARY CARE PLLC
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Dates
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Enumeration Date | 09/17/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 160 N POINTE BLVD STE 106
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City | LANCASTER
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State | PA
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Zip | 17601-4134
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Country | US
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Telephone | 717-500-3930
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Fax |
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Provider Business Mailing Address
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Address Line | 652 OAKWOOD LN
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City | LANCASTER
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State | PA
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Zip | 17603-2451
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Country | US
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Telephone | 713-410-8087
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | DR. EFREM BOLANO MAGTAGNOB
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Credential | MD
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Telephone | 713-410-8087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | NULL
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