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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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