Basic Information
| Provider Information | |||||||||
| NPI: | 1841782026 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEHIGH VALLEY PHYSICIAN GROUP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LVPG FAMILY MEDICINE- RICHLAND TOWNSHIP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 783311 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191783311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848844500 | ||||||||
| FaxNumber: | 4848840699 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 W PUMPING STATION RD STE 3 | ||||||||
| Address2: | |||||||||
| City: | QUAKERTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189512345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155294240 | ||||||||
| FaxNumber: | 2155294262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2018 | ||||||||
| LastUpdateDate: | 11/09/2018 | ||||||||
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| AuthorizedOfficialLastName: | SANTIAGO | ||||||||
| AuthorizedOfficialFirstName: | BREANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ENROLLMENT SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 4848840661 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LEHIGH PHYSICIAN GROUP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.