Organization
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Active
Other names
Wellspan OB/GYN
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, STE 125, EPHRATA, PA 17522-1761
(717) 721-5763
(717) 721-5712
Mailing address
4131 OREGON PIKE, SUITE C, EPHRATA, PA 17522-9550
(717) 859-5161
(717) 859-5169
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013977730007
—
PA
Enumeration date
07/10/2006
Last updated
06/12/2015
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