MEDICARE: REGIONAL GASTROENTEROLOGY ASSOCIATES OF LANCASTER, LTD

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	261QE0800X	Endoscopy Clinic/Center		PA

General Provider Information

NPI Number	:	1396877726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL GASTROENTEROLOGY ASSOCIATES OF LANCASTER, LTD

Provider Business Mailing Address
First Line	:	2104 HARRISBURG PIKE
Second Line	:	PO BOX 3200
City	:	LANCASTER
State	:	PA
Zip	:	17604-3200
Country	:	US
Telephone Number	:	717-544-3400
Fax Number	:	717-544-3408

Provider Business Practice Location Address
First Line	:	4140 OREGON PIKE
Second Line	:
City	:	EPHRATA
State	:	PA
Zip	:	17522
Country	:	US
Telephone Number	:	717-544-3400
Fax Number	:	717-544-3408

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DALE WHITEBLOOM
Credential	:	DO
Telephone Number	:	717-544-3400

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	06/15/2012

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