MEDICARE: ST. LUKE'S WARREN PHYSICIAN GROUP, PC

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	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1275884447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LUKE'S WARREN PHYSICIAN GROUP, PC

Provider Business Mailing Address
First Line	:	801 OSTRUM ST
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18015-1000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 MEMORIAL PKWY STE 100
Second Line	:
City	:	PHILLIPSBURG
State	:	NJ
Zip	:	08865-2748
Country	:	US
Telephone Number	:	908-859-6700
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SUSAN CHIAVAROLI
Credential	:
Telephone Number	:	484-526-3569

Provider Enumeration Date	:	09/27/2012
Last Update Date	:	06/25/2026

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