Provider Demographics
NPI: | 1477600450 |
---|---|
Name: | LEHIGH VALLEY PHYSICIAN GROUP |
Entity type: | Organization |
Organization Name: | LEHIGH VALLEY PHYSICIAN GROUP |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | SR VP & CHIEF VALUE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JENNIFER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | STEPHENS |
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: | 1250 S CEDAR CREST BLVD |
Practice Address - Street 2: | SUITE 210 |
Practice Address - City: | ALLENTOWN |
Practice Address - State: | PA |
Practice Address - Zip Code: | 18103-6224 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-402-8506 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | LEHIGH VALLEY PHYSICIAN GROUP |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2007-01-04 |
Last Update Date: | 2025-01-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty |