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Organization

PEQUEA VALLEY INTERNAL MEDICINE, INC.

Active
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Organization

PEQUEA VALLEY INTERNAL MEDICINE, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. JESSICA R LACORTE RN (PRACTICE ADMINISTRATOR)
(717) 560-3505
Entity
Organization

Contact information

Practice address
1725 OREGON PIKE, SUITE 107 B, LANCASTER, PA 17601-4206
(717) 560-3505
Mailing address
1725 OREGON PIKE, SUITE 107 B, LANCASTER, PA 17601-4206

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016560860002
—
PA
01
—
1646737
BLUESHIELD
PA
01
—
50041137
CAP BC
PA
01
—
DC7495
RR MCR
PA
Enumeration date
12/20/2006
Last updated
12/28/2007
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