MEDICARE: LEHIGH VALLEY PHYSICIAN GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1164123972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEHIGH VALLEY PHYSICIAN GROUP

Provider Business Mailing Address
First Line	:	PO BOX 783311
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-3311
Country	:	US
Telephone Number	:	484-884-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1353 STATE ROUTE 903
Second Line	:
City	:	JIM THORPE
State	:	PA
Zip	:	18229-2734
Country	:	US
Telephone Number	:	570-325-8393
Fax Number	:	570-325-8029

Authorized Official
Title or Position	:	SVP
Name	:	JAMES DEMOPOULOS
Credential	:
Telephone Number	:	484-862-3333

Provider Enumeration Date	:	03/17/2023
Last Update Date	:	04/21/2023

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