Provider Demographics
NPI:1740255124
Name:LANCASTER GENERAL MEDICAL GROUP
Entity type:Organization
Organization Name:LANCASTER GENERAL MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-544-5010
Mailing Address - Street 1:1159 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:PA
Mailing Address - Zip Code:17547-1628
Mailing Address - Country:US
Mailing Address - Phone:717-426-1131
Mailing Address - Fax:717-426-2068
Practice Address - Street 1:1159 RIVER RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:PA
Practice Address - Zip Code:17547-1628
Practice Address - Country:US
Practice Address - Phone:717-426-1131
Practice Address - Fax:717-426-2068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007327490088Medicaid
PA1019796OtherGATEWAY HEALTH PLAN
PA535947OtherAETNA HMO
PACN7614OtherRAILROAD MEDICARE
PA02364600OtherCAPITAL BLUE CROSS
PA5026097OtherAETNA NON-HMO
PAS1QKOtherGEISINGER HEALTH PLAN
PA430843OtherHIGHMARK BLUE SHIELD
PA5761OtherAETNA CAP OFFICE#
PAS1QKOtherGEISINGER HEALTH PLAN