Northern Lancaster County Medical Group

Primary specialty

Obstetrics PhysicianTaxonomy code 207VX0000X

Legal business name

NORTHERN LANCASTER COUNTY MEDICAL GROUP

Doing business as

Wellspan OB/GYN

Practice address

175 Martin Ave
Ste 125
Ephrata, PA 17522-1761

Phone

(717) 721-5763

Fax

(717) 721-5712

NPI assigned

Jul 10, 2006

Last updated

Jun 12, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles David Noll, DO

Title

Vice President

Phone

(717) 859-5161

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wellspan OB/GYN Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434067200000",
    "number": "1184658072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4131 OREGON PIKE",
            "address_2": "SUITE C",
            "city": "EPHRATA",
            "state": "PA",
            "postal_code": "175229550",
            "telephone_number": "717-859-5161",
            "fax_number": "717-859-5169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 MARTIN AVE",
            "address_2": "STE 125",
            "city": "EPHRATA",
            "state": "PA",
            "postal_code": "175221761",
            "telephone_number": "717-721-5763",
            "fax_number": "717-721-5712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LANCASTER COUNTY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2015-06-12",
        "status": "A",
        "authorized_official_last_name": "NOLL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "717-859-5161",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013977730007",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellspan OB/GYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Northeran Lancaster County Medical Group (Wellspan Internal Medicine)
• Northern Lancaster County Medical Group (Wellspan Family Medicine- Crossroads)
• Northern Lancaster County Medical Group (Internal Medicine Associates of Ephrata)
• Northern Lancaster County Medical Group (Wellspan Family Medicine - Trout Run)
• Northern Lancaster County Medical Group (Wellspan Plastic Surgery)
• Northern Lancaster County Medical Group (Wellspan Family Medicine-Lake Street)
• Northern Lancaster County Medical Group (Northern Lancaster Internal Medicine)
• Northern Lancaster County Medical Group (State Stree Family Practice)
• Northern Lancaster County Medical Group (Wellspan Hospitalist)
• Northern Lancaster County Medical Group (WellSpan General Surgery)

• Obstetrics Physician in Ephrata, PA
• Providers in Ephrata, PA by specialty
• Obstetrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.