MEDICARE: LEHIGH VALLEY PHYSICIAN 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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1942630827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEHIGH VALLEY PHYSICIAN GROUP

Provider Business Mailing Address
First Line	:	PO BOX 783311
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-3311
Country	:	US
Telephone Number	:	484-884-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1337 BLUE VALLEY DR
Second Line	:	STE 8
City	:	PEN ARGYL
State	:	PA
Zip	:	18072-1815
Country	:	US
Telephone Number	:	610-654-1200
Fax Number	:	610-654-1201

Authorized Official
Title or Position	:	VP CFO
Name	:	JOHN BERZINSKY
Credential	:
Telephone Number	:	484-884-4500

Provider Enumeration Date	:	11/14/2013
Last Update Date	:	08/14/2015

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