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NPI Code Detail

MEDICARE: ST. LUKE'S PHYSICIAN GROUP, INC.

MEDICARE: ST. LUKE'S PHYSICIAN GROUP, INC.
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
12084P0800XPsychiatry Physician
22084P0804XChild & Adolescent Psychiatry Physician
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326061581
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. LUKE'S PHYSICIAN GROUP, INC.
Provider Business Mailing Address
First Line : 801 OSTRUM ST
Second Line :
City : BETHLEHEM
State : PA
Zip : 18015-1000
Country : US
Telephone Number : 484-526-2400
Fax Number : 484-526-3697
Provider Business Practice Location Address
First Line : 257 BRODHEAD RD
Second Line :
City : BETHLEHEM
State : PA
Zip : 18017-8938
Country : US
Telephone Number : 484-822-5700
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : SUE CHIAVAROLI
Credential :
Telephone Number : 484-526-3569
Provider Enumeration Date : 07/26/2006
Last Update Date : 05/05/2023

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