Provider Demographics
NPI:1922477678
Name:LEHIGH VALLEY PHYSICIAN GROUP
Entity Type:Organization
Organization Name:LEHIGH VALLEY PHYSICIAN GROUP
Other - Org Name:LVPG OTOLARYNGOLOGY - 17TH STREET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-884-4500
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:
Practice Address - Street 1:401 N 17TH ST
Practice Address - Street 2:STE 210
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5034
Practice Address - Country:US
Practice Address - Phone:484-884-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEHIGH VALLEY PHYSICIAN GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-23
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty