| Wellspan Family Medicine-granite Run | |
|
264 Granite Run Dr Lancaster PA 17601-6804 | |
| (717) 721-8205 | |
| (717) 721-8251 |
| Full Name | Wellspan Family Medicine-granite Run |
|---|---|
| Speciality | Family Medicine |
| Location | 264 Granite Run Dr, Lancaster, Pennsylvania |
| Authorized Official Name and Position | Charles David Noll (VICE PRESIDENT) |
| Authorized Official Contact | 7178595161 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellspan Family Medicine-granite Run 264 Granite Run Dr Lancaster PA 17601-6804 Ph: (717) 721-8205 | Wellspan Family Medicine-granite Run 264 Granite Run Dr Lancaster PA 17601-6804 Ph: (717) 721-8205 |
| NPI Number | 1184888778 |
|---|---|
| Provider Enumeration Date | 07/14/2008 |
| Last Update Date | 10/15/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184888778 | NPI | - | NPPES |
| 1013977730021 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD032838L (Pennsylvania) | Primary |
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