Provider Demographics
NPI:1073576831
Name:BACA PEDIATRICS
Entity Type:Organization
Organization Name:BACA PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIUSEPPE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANCELLOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-733-0790
Mailing Address - Street 1:159 N READING RD
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1671
Mailing Address - Country:US
Mailing Address - Phone:717-733-0790
Mailing Address - Fax:717-733-1802
Practice Address - Street 1:159 N READING RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1671
Practice Address - Country:US
Practice Address - Phone:717-733-0790
Practice Address - Fax:717-733-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
02629500OtherCAPITAL BLUE CROSS