Provider Demographics
NPI:1316912785
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:VP FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-544-5010
Mailing Address - Street 1:505 HISTORIC DR
Mailing Address - Street 2:
Mailing Address - City:STRASBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17579-1479
Mailing Address - Country:US
Mailing Address - Phone:717-687-0313
Mailing Address - Fax:717-687-3604
Practice Address - Street 1:505 HISTORIC DR
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:PA
Practice Address - Zip Code:17579-1479
Practice Address - Country:US
Practice Address - Phone:717-687-0313
Practice Address - Fax:717-687-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS1QJOtherGEISINGER HEALTH PLAN
PA010606OtherHIGHMARK BLUE SHIELD
PA1518984OtherGATEWAY HEALTH PLAN
PA7653319OtherAETNA NON-HMO
PA2703425OtherAETNA HMO
PA530947OtherAETNA CAP OFFICE#
PA1007327490416Medicaid
PACG7288OtherRAILROAD MEDICARE
PA7653319OtherAETNA
PA03129700OtherCAPITAL BLUE CROSS
PA1007327490101Medicaid