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136 A & B Lake Street Ephrata PA 17522-2415 | |
(717) 721-7718 | |
(717) 721-7726 |
Full Name | |
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Speciality | Family Medicine |
Location | 136 A & B Lake Street, Ephrata, 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 |
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136 Lake St Ephrata PA 17522-2415 Ph: (717) 721-7718 | 136 A & B Lake Street Ephrata PA 17522-2415 Ph: (717) 721-7718 |
NPI Number | 1346344561 |
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Provider Enumeration Date | 09/08/2006 |
Last Update Date | 10/15/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346344561 | NPI | - | NPPES |
DD6938 | Other | PA | RAILROAD MEDICARE |
1013977730008 | Medicaid | PA | |
1746343 | Other | PA | BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |