Provider Demographics
NPI:1467683185
Name:LANCASTER UROLOGICAL GROUP, INC.
Entity Type:Organization
Organization Name:LANCASTER UROLOGICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BARTGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-397-4254
Mailing Address - Street 1:2110 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-397-4254
Mailing Address - Fax:717-735-8154
Practice Address - Street 1:222 WILLOW VALLEY LAKES DR
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9670
Practice Address - Country:US
Practice Address - Phone:717-464-9335
Practice Address - Fax:717-735-8154
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANCASTER UROLOGICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-29
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6263480004Medicare NSC