Provider Demographics
NPI:1174353676
Name:LANCASTER GENERAL MEDICAL GROUP
Entity type:Organization
Organization Name:LANCASTER GENERAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OPERATIONAL FIN
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-544-5010
Mailing Address - Street 1:26 N CEDAR STREET
Mailing Address - Street 2:MELISSA PAULIN 2084 2ND FLR
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543
Mailing Address - Country:US
Mailing Address - Phone:717-544-7279
Mailing Address - Fax:
Practice Address - Street 1:175 S CENTERVILLE ROAD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-0000
Practice Address - Country:US
Practice Address - Phone:717-299-4644
Practice Address - Fax:717-390-2916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty