Organization
LEBANON PEDIATRIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACQUELYN S. FRAZIER (BILLING SUPERVISOR)
(717) 838-6462
Entity
Organization
Contact information
Practice address
503 OAK ST, LEBANON, PA 17042-6246
(717) 272-7695
Mailing address
503 OAK ST, LEBANON, PA 17042-6246
(717) 272-7695
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD016889E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01543601
CAPITAL BLUE CROSS
PA
05
—
1008514360001
—
PA
01
—
407754
HIGHMARK BLUE SHIELD
PA
Enumeration date
08/13/2006
Last updated
08/22/2020
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