MEDICARE: LANCASTER CARDIOLOGY GROUP, LLC

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	174400000X	Specialist		PA

General Provider Information

NPI Number	:	1669633830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANCASTER CARDIOLOGY GROUP, LLC

Provider Business Mailing Address
First Line	:	1821 OREGON PIKE
Second Line	:	SUITE 2
City	:	LANCASTER
State	:	PA
Zip	:	17601-6466
Country	:	US
Telephone Number	:	717-569-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 OREGON PIKE
Second Line	:	SUITE 2
City	:	LANCASTER
State	:	PA
Zip	:	17601-6466
Country	:	US
Telephone Number	:	717-569-7100
Fax Number	:

Authorized Official
Title or Position	:	CARDIOLOGIST/INTERNALIST
Name	:	BERTRAM L JOHNSON
Credential	:	M.D.
Telephone Number	:	717-569-7100

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	06/20/2008

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