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Organization
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Active
Organization
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Active
Other names
Wellspan Family Medicine-Granite Run
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES DAVID NOLL DO (VICE PRESIDENT)
(717) 859-5161
Entity
Organization
Contact information
Practice address
264 GRANITE RUN DR, LANCASTER, PA 17601-6804
(717) 721-8205
(717) 721-8251
Mailing address
264 GRANITE RUN DR, LANCASTER, PA 17601-6804
(717) 721-8205
(717) 721-8251
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD032838L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013977730021
—
PA
Enumeration date
07/14/2008
Last updated
10/15/2015
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