MEDICARE: LANCASTER GENERAL MEDICAL 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	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	CN7614	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	676677	OTHER	PA	AETNA CAP OFFICE#
2	3974095	OTHER	PA	AETNA HMO
3	1648901	OTHER	PA	HIGHMARK BLUE SHIELD
4	50041081	OTHER	PA	CAPITAL BLUE CROSS
5	1540390	OTHER	PA	GATEWAY HEALTH PLAN
6	7315670	OTHER	PA	AETNA NON-HMO
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	S1QE	OTHER	PA	GEISINGER HEALTH PLAN

General Provider Information

NPI Number	:	1447231923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANCASTER GENERAL MEDICAL GROUP

Provider Business Mailing Address
First Line	:	405 MAIN ST
Second Line	:
City	:	LANDISVILLE
State	:	PA
Zip	:	17538-1812
Country	:	US
Telephone Number	:	717-898-2413
Fax Number	:	717-898-9142

Provider Business Practice Location Address
First Line	:	405 MAIN ST
Second Line	:
City	:	LANDISVILLE
State	:	PA
Zip	:	17538-1812
Country	:	US
Telephone Number	:	717-898-2413
Fax Number	:	717-898-9142

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEROME I GOTTLIEB
Credential	:	M.D.
Telephone Number	:	717-544-4001

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	08/20/2007

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Directions to “LANCASTER GENERAL MEDICAL GROUP ” Practice Location

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