Provider Demographics
NPI:1285676817
Name:NORTHERN LANCASTER COUNTY MEDICAL GROUP
Entity Type:Organization
Organization Name:NORTHERN LANCASTER COUNTY MEDICAL GROUP
Other - Org Name:DENVER FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF NLCMG
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 1:63 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS
Mailing Address - State:PA
Mailing Address - Zip Code:17578-9203
Mailing Address - Country:US
Mailing Address - Phone:717-335-3311
Mailing Address - Fax:717-335-3315
Practice Address - Street 1:63 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:STEVENS
Practice Address - State:PA
Practice Address - Zip Code:17578-9203
Practice Address - Country:US
Practice Address - Phone:717-335-3311
Practice Address - Fax:717-335-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA193400000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013977730005Medicaid
PA1746265OtherBLUE SHIELD
PADD6938OtherRAILROAD MEDICARE
PA1746265OtherBLUE SHIELD