Organization
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Active
Other names
WellSpan General Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES DAVID NOLL DO (VICE PRESIDENT)
(717) 859-5161
Entity
Organization
Contact information
Practice address
175 MARTIN AVE, SUITE 350, EPHRATA, PA 17522-1761
(717) 733-2055
(717) 738-4114
Mailing address
4131 OREGON PIKE, SUITE C, EPHRATA, PA 17522-9550
(717) 859-5161
(717) 859-5169
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013977730022
—
PA
Enumeration date
11/12/2008
Last updated
06/07/2016
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