Provider Demographics
NPI:1912988114
Name:LANCASTER GENERAL MEDICAL GROUP
Entity Type:Organization
Organization Name:LANCASTER GENERAL MEDICAL GROUP
Other - Org Name:PENN MEDICINE LANCASTER GENERAL HEALTH PHYSICIANS INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-544-5010
Mailing Address - Street 1:2110 HARRISBURG PIKE STE 100
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-3191
Mailing Address - Fax:717-544-3637
Practice Address - Street 1:2110 HARRISBURG PIKE STE 100
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3191
Practice Address - Fax:717-544-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA406992OtherHIGHMARK BLUE SHIELD
PA5720505OtherAETNA NON-HMO
PA2117135OtherAETNA HMO
PA502924OtherAETNA CAP OFFICE#
PA1007327490100Medicaid
PA1519062OtherGATEWAY HEALTH PLAN
PAS1QAOtherGEISINGER HEALTH PLAN
PACG4751OtherRAILROAD MEDICARE
PA03092900OtherCAPITAL BLUE CROSS
PA5720505OtherAETNA NON-HMO