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Organization
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Active
Organization
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Active
Other names
Wellspan Family Medicine- Crossroads
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES DAVID NOLL DO (VICE PRESIDENT)
(717) 859-5161
Entity
Organization
Contact information
Practice address
4131 OREGON PIKE, EPHRATA, PA 17522-9550
(717) 859-1123
(717) 859-2898
Mailing address
4131 OREGON PIKE, SUITE C, EPHRATA, PA 17522-9550
(717) 859-5161
(717) 859-5169
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000168397
UNISON HEALTH PLAN
PA
05
—
1013977730004
—
PA
01
—
1517082
GATEWAY GROUP NUMBER
PA
01
—
2412013000
BLUE SHIELD PA
PA
01
—
4620221
AETNA GROUP NUMBER
PA
01
—
50051184
CAPITAL BLUE CROSS GROUP
PA
01
—
DD6938
RAILROAD MEDICARE
PA
Enumeration date
07/03/2006
Last updated
05/05/2015
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