Organization
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Active
Other names
Wellspan Plastic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES DAVID NOLL DO (VICE PRESIDENT)
(717) 859-5161
Entity
Organization
Contact information
Practice address
175 MARTIN AVE, SUITE 320, EPHRATA, PA 17522-1761
(717) 721-5800
(717) 721-5858
Mailing address
4131 OREGON PIKE, SUITE C, EPHRATA, PA 17522-9550
(717) 859-5161
(717) 859-5169
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013977730009
—
PA
01
—
1746345
BLUE SHIELD
PA
01
—
DD6938
RAILROAD MEDICARE
PA
Enumeration date
07/03/2006
Last updated
05/28/2015
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