Provider Demographics
NPI:1801879259
Name:LANCASTER GENERAL MEDICAL GROUP
Entity type:Organization
Organization Name:LANCASTER GENERAL MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FINANCIAL SERVICES
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 1:676 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-1426
Mailing Address - Country:US
Mailing Address - Phone:717-354-4671
Mailing Address - Fax:717-354-2478
Practice Address - Street 1:676 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-1426
Practice Address - Country:US
Practice Address - Phone:717-354-4671
Practice Address - Fax:717-354-2478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6345OtherAETNA HMO
PA03093500OtherCAPITAL BLUE CROSS
PA1007327490082Medicaid
PACB0152OtherRAILROAD MEDICARE
PA1518493OtherGATEWAY HEALTH PLAN
PA5753OtherAETNA CAP OFFICE#
PAS1QIOtherGEISINGER HEALTH PLAN
PA020410OtherHIGHMARK BLUE SHIELD
PA5821111OtherAETNA NON-HMO
PA5821111OtherAETNA NON-HMO