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General NPI Number Information
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NPI Number | 1851956171
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Entity Type | Organization
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Legal Business Name | LEHIGH VALLEY PHYSICIAN GROUP
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 1720 W FAIRMONT ST
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City | ALLENTOWN
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State | PA
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Zip | 18104-3118
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Country | US
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Telephone | 610-841-2798
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Fax | 610-841-2796
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Provider Business Mailing Address
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Address Line | 1605 N CEDAR CREST BLVD STE 110B
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City | ALLENTOWN
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State | PA
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Zip | 18104-2351
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Country | US
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Telephone | 610-973-1410
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Fax | 610-973-1449
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT LIAISON
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Name | BREANNA SANTIAGO
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Credential |
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Telephone | 484-884-0661
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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 |
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License Number State |
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