Provider Demographics
NPI:1922073865
Name:LANCASTER GENERAL MEDICAL GROUP
Entity Type:Organization
Organization Name:LANCASTER GENERAL MEDICAL GROUP
Other - Org Name:PENN MEDICINE LGHP ROSEVILLE PEDIATRICS
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 1:160 N POINTE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4134
Mailing Address - Country:US
Mailing Address - Phone:717-569-6481
Mailing Address - Fax:717-569-5213
Practice Address - Street 1:160 N POINTE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4134
Practice Address - Country:US
Practice Address - Phone:717-569-6481
Practice Address - Fax:717-569-5213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1508046OtherGATEWAY HEALTH PLAN
PA51203OtherAETNA HMO
PAS1BXOtherGEISINGER HEALTH PLAN
PA1007327490099Medicaid
PA02404600OtherCAPITAL BLUE CROSS
PA874348OtherHIGHMARK BLUE SHIELD
PA1001184OtherAMERIHEALTH MERCY
PA4482843OtherAETNA NON-HMO
PA5803OtherAETNA CAP OFFICE#
PA616918Medicare PIN