Provider Demographics
NPI:1902868466
Name:LANCASTER INTERNAL MEDICINE GROUP
Entity Type:Organization
Organization Name:LANCASTER INTERNAL MEDICINE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-393-8131
Mailing Address - Street 1:817 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2009
Mailing Address - Country:US
Mailing Address - Phone:717-393-8131
Mailing Address - Fax:717-393-9107
Practice Address - Street 1:817 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2009
Practice Address - Country:US
Practice Address - Phone:717-393-8131
Practice Address - Fax:717-393-9107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007432410004Medicaid
PA1007432410004Medicaid