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	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1001184	OTHER	PA	AMERIHEALTH MERCY
2	51203	OTHER	PA	AETNA HMO
3	5803	OTHER	PA	AETNA CAP OFFICE#
4	874348	OTHER	PA	HIGHMARK BLUE SHIELD
5	S1BX	OTHER	PA	GEISINGER HEALTH PLAN
6	4482843	OTHER	PA	AETNA NON-HMO
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	02404600	OTHER	PA	CAPITAL BLUE CROSS
9	1508046	OTHER	PA	GATEWAY HEALTH PLAN

General Provider Information

NPI Number	:	1922073865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANCASTER GENERAL MEDICAL GROUP

Provider Business Mailing Address
First Line	:	51 PETERS RD STE 202
Second Line	:
City	:	LITITZ
State	:	PA
Zip	:	17543-7685
Country	:	US
Telephone Number	:	717-569-6481
Fax Number	:	717-569-5213

Provider Business Practice Location Address
First Line	:	51 PETERS RD STE 202
Second Line	:
City	:	LITITZ
State	:	PA
Zip	:	17543-7685
Country	:	US
Telephone Number	:	717-569-6481
Fax Number	:	717-569-5213

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	03/27/2025

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Directions to “LANCASTER GENERAL MEDICAL GROUP ” Practice Location

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