Provider Demographics
NPI: | 1457309650 |
---|---|
Name: | LEHIGH VALLEY PHYSICIAN GROUP |
Entity Type: | Organization |
Organization Name: | LEHIGH VALLEY PHYSICIAN GROUP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ENROLLMENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BREANNA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SANTIAGO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 484-884-0661 |
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: | 2100 MACK BLVD FL 4 |
Practice Address - Street 2: | |
Practice Address - City: | ALLENTOWN |
Practice Address - State: | PA |
Practice Address - Zip Code: | 18103-5622 |
Practice Address - Country: | US |
Practice Address - Phone: | 484-884-4500 |
Practice Address - Fax: | 484-884-0699 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-04 |
Last Update Date: | 2019-03-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
204F00000X, 207P00000X, 207Q00000X, 207R00000X, 207T00000X, 207V00000X, 208000000X, 208100000X, 208200000X, 2084N0400X, 208600000X, 208M00000X, 363A00000X, 363L00000X | ||
PA | 213E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 204F00000X | Allopathic & Osteopathic Physicians | Transplant Surgery | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | ========= | Other | TAX ID |