Provider Demographics
NPI:1790160901
Name:LANCASTER MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:LANCASTER MEDICAL GROUP, LLC
Other - Org Name:MARK W. EVANS, DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-291-8078
Mailing Address - Street 1:90 GOOD DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4360
Mailing Address - Country:US
Mailing Address - Phone:717-299-3020
Mailing Address - Fax:
Practice Address - Street 1:90 GOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4360
Practice Address - Country:US
Practice Address - Phone:717-299-3020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty