MEDICARE: LANCASTER GENERAL MEDICAL GROUP

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0000X	Obstetrics Physician
2	207Q00000X	Family Medicine Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	CG7288	OTHER	PA	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S1QJ	OTHER	PA	GEISINGER HEALTH PLAN
2	010606	OTHER	PA	HIGHMARK BLUE SHIELD
3	1518984	OTHER	PA	GATEWAY HEALTH PLAN
4	7653319	OTHER	PA	AETNA NON-HMO
5	2703425	OTHER	PA	AETNA HMO
6	530947	OTHER	PA	AETNA CAP OFFICE#
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	7653319	OTHER	PA	AETNA
10	03129700	OTHER	PA	CAPITAL BLUE CROSS

NPI Number	:	1316912785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANCASTER GENERAL MEDICAL GROUP

Provider Business Mailing Address
First Line	:	505 HISTORIC DR
Second Line	:
City	:	STRASBURG
State	:	PA
Zip	:	17579-1479
Country	:	US
Telephone Number	:	717-687-0313
Fax Number	:	717-687-3604

Provider Business Practice Location Address
First Line	:	505 HISTORIC DR
Second Line	:
City	:	STRASBURG
State	:	PA
Zip	:	17579-1479
Country	:	US
Telephone Number	:	717-687-0313
Fax Number	:	717-687-3604

Authorized Official
Title or Position	:	VP FINANCIAL SERVICES
Name	:	DENISE A KENNEDY
Credential	:
Telephone Number	:	717-544-5010

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	12/18/2024