Organization
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Active
Other names
WellSpan Family & Sports Medicine-Cocalico
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES DAVID NOLL DO (VICE PRESIDENT)
(717) 859-5161
Entity
Organization
Contact information
Practice address
30 W. SWARTZVILLE ROAD, SUITE 1, REINHOLDS, PA 17569
(717) 484-4347
(717) 484-0968
Mailing address
4131 OREGON PIKE, SUITE C, EPHRATA, PA 17522-9550
(717) 859-5161
(717) 859-5169
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013977730024
—
PA
Enumeration date
06/03/2010
Last updated
06/15/2015
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