Provider Demographics
NPI:1922037126
Name:LANCASTER GENERAL MEDICAL GROUP
Entity Type:Organization
Organization Name:LANCASTER GENERAL MEDICAL GROUP
Other - Org Name:PENN MEDICINE LGHP FAMILY MEDICINE COUNTY LINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-544-5010
Mailing Address - Street 1:5360 LINCOLN HIGHWAY EAST, STORE #15
Mailing Address - Street 2:VILLAGE AT GAP
Mailing Address - City:GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17527-9461
Mailing Address - Country:US
Mailing Address - Phone:717-442-8111
Mailing Address - Fax:717-442-8981
Practice Address - Street 1:5360 LINCOLN HIGHWAY EAST, STORE #15
Practice Address - Street 2:VILLAGE AT GAP
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527-9461
Practice Address - Country:US
Practice Address - Phone:717-442-8111
Practice Address - Fax:717-442-8981
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANCASTER GENERAL MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-01
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007327490138Medicaid
PA430843Medicare PIN