Provider Demographics
NPI:1083665038
Name:NORTHERN LANCASTER COUNTY MEDICAL GROUP
Entity Type:Organization
Organization Name:NORTHERN LANCASTER COUNTY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP NLCMG
Authorized Official - Prefix:
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:717-859-2803
Practice Address - Street 1:4224 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17508
Practice Address - Country:US
Practice Address - Phone:717-859-2038
Practice Address - Fax:717-859-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA092914Medicare ID - Type UnspecifiedMEDICARE