Individual
DR. PAUL GRAY LACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4387 STURBRIDGE DR, HARRISBURG, PA 17110-3673
(717) 238-3111
Mailing address
423 N 21ST ST, SUITE 100, CAMP HILL, PA 17011-2207
(717) 238-3111
(717) 238-1896
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD 044099 L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014076520002
—
PA
01
—
4363687
AETNA US HEALTHCARE
PA
01
—
50058922
CAPITAL BLUE CROSS
PA
01
—
739366
HIGHMARK BLUE SHIELD
PA
01
—
F53848
HEALTHAMERICA
PA
01
—
P00318652
RAILROAD MEDICARE
PA
Enumeration date
07/26/2005
Last updated
09/15/2020
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