Organization
LANCASTER SURGICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY L MAZZACCO MD (PRESIDENT)
(717) 544-3626
Entity
Organization
Contact information
Practice address
2104 HARRISBURG PIKE, SUITE 200, LANCASTER, PA 17604-3200
(717) 544-3626
(717) 544-3628
Mailing address
PO BOX 3200, 2104 HARRISBURG PIKE SUITE 200, LANCASTER, PA 17604-3200
(717) 544-3626
(717) 544-3628
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
087649
—
PA
01
—
2450800
CBC
PA
01
—
51523
AETNA
PA
01
—
CD0118
RAILROAD MEDICARE
PA
Enumeration date
05/11/2006
Last updated
11/23/2009
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