Provider Demographics
NPI:1134164676
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:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-544-5658
Mailing Address - Street 1:1261 DIVISION HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-8822
Mailing Address - Country:US
Mailing Address - Phone:717-738-0660
Mailing Address - Fax:717-738-0658
Practice Address - Street 1:1261 DIVISION HWY STE 1
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-8822
Practice Address - Country:US
Practice Address - Phone:717-738-0660
Practice Address - Fax:717-738-0658
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANCASTER GENERAL MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-18
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA336301OtherAETNA CAP OFFICE#
PAS1QFOtherGEISINGER HEALTH PLAN
PA50060200OtherCAPITAL BLUE CROSS
PA1875158OtherHIGHMARK BLUE SHIELD
PA1007327490206Medicaid
PA7991794OtherAETNA NON-HMO
PA1555387OtherGATEWAY HEALTH PLAN
PA1282458OtherAETNA HMO
PA7991794OtherAETNA NON-HMO
PA1282458OtherAETNA HMO