Provider Demographics
NPI:1568612760
Name:LANCASTER PEDIATRICS, PA
Entity Type:Organization
Organization Name:LANCASTER PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUNIYA
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-480-2803
Mailing Address - Street 1:2850 N RIDGE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3464
Mailing Address - Country:US
Mailing Address - Phone:410-480-2803
Mailing Address - Fax:410-480-2806
Practice Address - Street 1:2850 N RIDGE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3464
Practice Address - Country:US
Practice Address - Phone:410-480-2803
Practice Address - Fax:410-480-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054201208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404110100Medicaid
MDH17029Medicare UPIN
MD285LP912Medicare PIN