Provider Demographics
NPI:1003995960
Name:NORTHERN LANCASTER COUNTY MEDICAL GROUP
Entity Type:Organization
Organization Name:NORTHERN LANCASTER COUNTY MEDICAL GROUP
Other - Org Name:GRACE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIZIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-738-2280
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17508-0398
Mailing Address - Country:US
Mailing Address - Phone:717-859-2038
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHLANDS DR
Practice Address - Street 2:SUITE 204
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7693
Practice Address - Country:US
Practice Address - Phone:717-626-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty