| Lackawanna Medical Group Pc | |
|
201 Smallacombe Dr Scranton PA 18508-2616 | |
| (570) 961-0171 | |
| (570) 207-2411 |
| Full Name | Lackawanna Medical Group Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 201 Smallacombe Dr, Scranton, Pennsylvania |
| Authorized Official Name and Position | Charles Thomas Grad (BUSINESS MANAGER) |
| Authorized Official Contact | 5703481130 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lackawanna Medical Group Pc 201 Smallacombe Dr Scranton PA 18508-2616 Ph: (570) 961-0171 | Lackawanna Medical Group Pc 201 Smallacombe Dr Scranton PA 18508-2616 Ph: (570) 961-0171 |
| NPI Number | 1770650962 |
|---|---|
| Provider Enumeration Date | 11/30/2006 |
| Last Update Date | 03/03/2016 |
| Medicare PECOS PAC ID | 6800870882 |
|---|---|
| Medicare Enrollment ID | O20040616001211 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770650962 | NPI | - | NPPES |
| 000676727 | Medicaid | PA |
| Provider Name | Martha Sue Ghosh |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1861460412 PECOS PAC ID: 7810965514 Enrollment ID: I20040921000404 |
| Provider Name | Frank A Milani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871651695 PECOS PAC ID: 5496715013 Enrollment ID: I20090917000481 |
| Provider Name | Emma Rubin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902965924 PECOS PAC ID: 5294911293 Enrollment ID: I20110509000390 |
| Provider Name | Eugene D Harasym |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144267790 PECOS PAC ID: 6406755941 Enrollment ID: I20110524000265 |
| Provider Name | Charles Grad |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1093723322 PECOS PAC ID: 2860452489 Enrollment ID: I20111115000087 |
| Provider Name | Amanda M Grippo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841622610 PECOS PAC ID: 2860702172 Enrollment ID: I20151116002427 |
| Provider Name | Theresa B Germano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740839273 PECOS PAC ID: 4183044159 Enrollment ID: I20201013000678 |
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