Provider Demographics
NPI:1083600290
Name:LANCASTER GENERAL MEDICAL GROUP
Entity Type:Organization
Organization Name:LANCASTER GENERAL MEDICAL GROUP
Other - Org Name:PENN MEDICINE LGHP FAMILY MEDICINE EAST PETERSBURG
Other - Org Type:Doing Business As
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 1:5665 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520-1513
Mailing Address - Country:US
Mailing Address - Phone:717-569-7011
Mailing Address - Fax:717-569-8694
Practice Address - Street 1:5665 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST PETERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17520-1513
Practice Address - Country:US
Practice Address - Phone:717-569-7011
Practice Address - Fax:717-569-8694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA515156OtherAETNA HMO
PA5634046OtherAETNA NON-HMO
PA5702OtherAETNA CAP OFFICE#
PA03093300OtherCAPITAL BLUE CROSS
PACN7460OtherRAILROAD MEDICARE
PA1007327490104Medicaid
PA174248OtherHIGHMARK BLUE SHIELD
PA1518490OtherGATEWAY HEALTH PLAN
PAS1QCOtherGEISINGER HEALTH PLAN
PA174248Medicare PIN