Provider Demographics
NPI:1689604704
Name:NEPHROLOGY ASSOCIATES OF LANCASTER LTD
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES OF LANCASTER LTD
Other - Org Name:HYPERTENSION AND KIDNEY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOCK-HAGERSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CPPM
Authorized Official - Phone:717-544-3234
Mailing Address - Street 1:2110 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604
Mailing Address - Country:US
Mailing Address - Phone:717-544-3232
Mailing Address - Fax:717-544-3238
Practice Address - Street 1:2110 HARRISBURG PIKE
Practice Address - Street 2:SUITE 310
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17604
Practice Address - Country:US
Practice Address - Phone:717-544-3232
Practice Address - Fax:717-544-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherTAX ID #