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Organization
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Active
Organization
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Active
Other names
Wellspan Family Medicine - Trout Run
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES DAVID NOLL DO (VICE PRESIDENT)
(717) 851-5161
Entity
Organization
Contact information
Practice address
808 PLEASANTVIEW DR, EPHRATA, PA 17522-1644
(717) 733-9090
(717) 733-8982
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
05
—
1013977730013
—
PA
01
—
1746358
BLUE SHIELD
PA
01
—
DD6938
RAILROAD MEDICARE
PA
Enumeration date
07/10/2006
Last updated
05/28/2015
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