| NPI | 1346344561 |
|---|---|
| Doing Business As | WELLSPAN FAMILY MEDICINE-LAKE STREET |
| Entity Type | Organization |
| Authorized Contact | CHARLES DAVID NOLL Vice President 717-859-5161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2015-10-15 |