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618 Cornwall Rd Building 2 Lebanon PA 17042-7089 | |
(717) 279-6700 | |
(717) 279-6759 |
Full Name | |
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Speciality | Pediatrics |
Location | 618 Cornwall Rd, Lebanon, Pennsylvania |
Authorized Official Name and Position | Jody M Boger (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 7172707780 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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P.o. Box 300 Lebanon PA 17042-0300 Ph: (717) 270-7780 | 618 Cornwall Rd Building 2 Lebanon PA 17042-7089 Ph: (717) 279-6700 |
NPI Number | 1760510523 |
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Provider Enumeration Date | 03/01/2007 |
Last Update Date | 10/05/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1760510523 | NPI | - | NPPES |
001864024 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
208000000X | Pediatrics | (* (Not Available)) | Primary |
Agape Family Medicine, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 410 Cumberland St, Lebanon, PA 17042 Phone: 717-270-0335 Fax: 717-270-9740 | |
Lebanon Family Health Service Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 615 Cumberland St, Lebanon, PA 17042 Phone: 717-273-6741 Fax: 717-273-6337 |