1790340586 NPI number — LANCASTER GENERAL MEDICAL GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790340586 NPI number — LANCASTER GENERAL MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANCASTER GENERAL MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PENN MEDICINE LGHP UROGYNECOLOGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790340586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1030 NEW HOLLAND AVENUE
Provider Second Line Business Mailing Address:
BLDG 12A SUITE 200
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17601-5690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-544-7279
Provider Business Mailing Address Fax Number:
717-544-4296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
690 GOOD DR FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17601-2433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-544-0700
Provider Business Practice Location Address Fax Number:
717-544-0709
Provider Enumeration Date:
05/07/2019

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207VF0040X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2088F0040X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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