Basic Information
| Provider Information | |||||||||
| NPI: | 1831810753 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEHIGH VALLEY PHYSICIAN GROUP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WEST END MEDICAL ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 N CEDAR CREST BLVD STE 110B | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843301377 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1310 ROUTE 209 STE 103 | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183317751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109514500 | ||||||||
| FaxNumber: | 6109514600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2022 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | DEMOPOULOS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP & COO LVPG | ||||||||
| AuthorizedOfficialTelephone: | 4848623333 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LEHIGH VALLEY PHYSICIAN GROUP | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.