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Organization
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Active
Organization
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Active
Other names
WellSpan Family Medicine - Meadowbrook
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES DAVID NOLL DO (VICE PRESIDENT)
(717) 859-5161
Entity
Organization
Contact information
Practice address
337 W MAIN ST, SUITE 100, LEOLA, PA 17540-2109
(717) 656-6122
(717) 656-0142
Mailing address
4131 OREGON PIKE, SUITE C, EPHRATA, PA 17522-9550
(717) 859-5161
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013977730018
—
PA
01
—
1517089
GATEWAY
PA
01
—
1746348
BLUE SHIELD
PA
01
—
50051234
CAPITAL BLUE CROSS
PA
01
—
5372553
AETNA
PA
01
—
DD6938
RR MEDICARE
PA
Enumeration date
05/26/2006
Last updated
05/05/2015
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