Provider Demographics
NPI:1942609599
Name:LEHIGH VALLEY PHYSICIAN GROUP
Entity Type:Organization
Organization Name:LEHIGH VALLEY PHYSICIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSI
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:484-884-0699
Practice Address - Street 1:564 W BROAD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6108
Practice Address - Country:US
Practice Address - Phone:570-501-6220
Practice Address - Fax:570-501-2795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty