Provider Demographics
NPI:1861460867
Name:LYCOMING INTERNAL MEDICINE, INC.
Entity type:Organization
Organization Name:LYCOMING INTERNAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VARSHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-398-1800
Mailing Address - Street 1:1 OUTLET LN STE 380
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-7814
Mailing Address - Country:US
Mailing Address - Phone:570-398-1800
Mailing Address - Fax:570-398-3320
Practice Address - Street 1:1 OUTLET LN STE 380
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-7814
Practice Address - Country:US
Practice Address - Phone:570-398-1800
Practice Address - Fax:570-398-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016518020003Medicaid
PA005796Medicare PIN