Provider Demographics
NPI:1598740508
Name:LANCASTER ORTHOPEDIC GROUP PC
Entity Type:Organization
Organization Name:LANCASTER ORTHOPEDIC GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT EXECUTIVE COMMITTEE
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-560-4200
Mailing Address - Street 1:231 GRANITE RUN DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6823
Mailing Address - Country:US
Mailing Address - Phone:717-560-4200
Mailing Address - Fax:717-560-6380
Practice Address - Street 1:231 GRANITE RUN DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6823
Practice Address - Country:US
Practice Address - Phone:717-560-4200
Practice Address - Fax:717-560-6380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA411676OtherHIGHMARK BLUE SHIELD
PACN5002OtherRAILROAD MEDICARE
PA02368200OtherCAPITAL BLUE CROSS
PA3631Medicare ID - Type Unspecified