# NORTHERN LANCASTER COUNTY MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wellspan OB/GYN
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184658072
- **Authorized official:** CHARLES DAVID NOLL DO (VICE PRESIDENT)
- **Authorized official phone:** (717) 859-5161

## Contact information

- **Practice address:** 175 MARTIN AVE, STE 125, EPHRATA, PA 17522-1761
- **Practice address phone:** (717) 721-5763
- **Practice address fax:** (717) 721-5712
- **Mailing address:** 4131 OREGON PIKE, SUITE C, EPHRATA, PA 17522-9550
- **Mailing address phone:** (717) 859-5161
- **Mailing address fax:** (717) 859-5169

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207VX0000X | Obstetrics Physician | — | NULL | Yes |
| 207VX0000X | Obstetrics Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/10/2006
- **Last updated:** 06/12/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1013977730007 | — | PA |