| Organization Name: | NORTHERN LANCASTER COUNTY MEDICAL GROUP |
| NPI Number: | 1184658072 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES DAVID NOLL (VICE PRESIDENT) |
| Mailing Address: | 175 Martin Ave Ste 125 Ephrata |
| State: | PA US |
| Postal Code: | 175221761 |
| Phone Number: | 7177215763 |
| Fax Number: | 7177215712 |
| NPI Enumeration Date: | 07/10/2006 |
| NPI Last Update Date: | 06/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207VX0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | Obstetrics |
| Taxonomy Definition: | |