Provider Demographics
NPI:1851341838
Name:LANCASTER SURGICAL GROUP PC
Entity Type:Organization
Organization Name:LANCASTER SURGICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAZZACCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-544-3626
Mailing Address - Street 1:PO BOX 3200
Mailing Address - Street 2:2104 HARRISBURG PIKE SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-3200
Mailing Address - Country:US
Mailing Address - Phone:717-544-3626
Mailing Address - Fax:717-544-3628
Practice Address - Street 1:2104 HARRISBURG PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17604-3200
Practice Address - Country:US
Practice Address - Phone:717-544-3626
Practice Address - Fax:717-544-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2450800OtherCBC
PA51523OtherAETNA
PACD0118OtherRAILROAD MEDICARE
PA087649Medicaid
PA087649Medicaid
PA094025Medicare PIN