Provider Demographics
NPI:1871657684
Name:LANCASTER GENERAL MEDICAL GROUP
Entity Type:Organization
Organization Name:LANCASTER GENERAL MEDICAL GROUP
Other - Org Name:LANCASTER NEUROLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:I
Authorized Official - Last Name:GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-544-4001
Mailing Address - Street 1:2106 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-0545
Mailing Address - Fax:717-544-0546
Practice Address - Street 1:2106 HARRISBURG PIKE
Practice Address - Street 2:SUITE 310
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-0545
Practice Address - Fax:717-544-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007327490098Medicaid
PA1472363OtherAETNA HMO
PA1925949OtherHIGHMARK BLUE SHIELD
PA7249870OtherAETNA NON-HMO
PA1562801OtherGATEWAY HEALTH PLAN
PA50065485OtherCAPITAL BLUE CROSS
PA788VOtherGEISINGER HEALTH PLAN
PA1562801OtherGATEWAY HEALTH PLAN