1023003647 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 1023003647 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 FAMILY MEDICINE ABBEYVILLE
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:
1023003647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 ABBEYVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17603-4603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-291-5991
Provider Business Mailing Address Fax Number:
717-291-5806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 ABBEYVILLE RD
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:
17603-4603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-291-5991
Provider Business Practice Location Address Fax Number:
717-291-5806
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5695 . This is a "AETNA CAP OFFICE#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: S1QD . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 515219 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007327490093 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 874429 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5190494 . This is a "AETNA NON-HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CN7058 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02361000 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1518491 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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