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Organization
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Active
Organization
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Active
Other names
State Stree Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA MALIZIA (VP NLCMG)
(717) 738-2280
Entity
Organization
Contact information
Practice address
11 S STATE ST, EPHRATA, PA 17522-2410
(717) 733-4559
Mailing address
PO BOX 398, BROWNSTOWN, PA 17508-0398
(717) 859-2038
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013977730012
—
PA
01
—
1517100
GATEWAY
PA
01
—
1746355
BLUE SHIELD
PA
01
—
50051253
BLUE CROSS
PA
01
—
7090090
AETNA
PA
01
—
DD6938
RR MEDICARE
PA
Enumeration date
06/03/2006
Last updated
04/20/2008
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