1. Home
  2. Directory
  3. Pennsylvania
  4. Scranton
  5. Internal Medicine
  6. NPI Profile

LACKAWANNA MEDICAL GROUP PC
NPI 1770650962
Internal Medicine in Scranton, PA

Active since November 30, 2006CLIA 39D0927570 · Waiver
201 SMALLACOMBE DR, SCRANTON, PA 18508(570) 961-0171(570) 207-2411 Get Directions Write a Review

NPPES record last updated: March 3, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Lackawanna Medical Group Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LACKAWANNA MEDICAL GROUP PC (NPI 1770650962) is a healthcare organization registered as an internal medicine in Scranton, Pennsylvania and active in the NPI registry since November 2006. The organization holds a CLIA Waiver certificate valid through April 22, 2027 and lists Charles Thomas Grad, Business Manager, as its authorized official.

NPPES Registry Identity

NPI1770650962
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameLACKAWANNA MEDICAL GROUP PC
Location Address201 SMALLACOMBE DRScranton, PA 18508-2616
Mailing Address201 Smallacombe DrScranton, PA 18508-2616 · (570) 961-0171 · Fax (570) 207-2411
Phone(570) 961-0171
Fax(570) 207-2411
Organization SubpartNo
Authorized OfficialCharles Thomas GradBusiness Manager · (570) 348-1130
Enumeration DateNovember 30, 2006
Last NPPES UpdateMarch 3, 2016
✔ NPI 1770650962 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 8

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedInternal Medicine · Cardiovascular DiseaseTaxonomy 207RC0000X
Also ListedInternal Medicine · GastroenterologyTaxonomy 207RG0100X
Also ListedNuclear Medicine · Nuclear CardiologyTaxonomy 207UN0901X
Also ListedPediatricsTaxonomy 208000000X
Also ListedPhysician AssistantTaxonomy 363A00000X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
201 SMALLACOMBE DR, Scranton, PA 18508
Open in Google Maps ↗

Other Identifiers 3

Medicare ID-Type Unspecified039284
Medicare ID-Type Unspecified536244
Medicaid000676727PA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 39D0927570

Lackawanna Medical Group PC · Scranton, PA
Active · expires Apr 22, 2027
CLIA Number39D0927570
Laboratory TypePhysician Office
Certificate Effective DateApril 23, 2025
Certificate Expiration DateApril 22, 2027
Laboratory DirectorDr. Charles T. Grad
Laboratory Phone(570) 961-0171
Laboratory LocationLackawanna Medical Group PC201 Smallacombe Drive Suite 100, Scranton, PA 18508
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NATALIE MILANI R.D.
Dietitian, Registered
201 SMALLACOMBE DR
SCRANTON, PA 18508
Lackawanna County (570) 961-0171
DR. GARY ADAM BEPPLER PHARM.D.
Pharmacist
201 SMALLACOMBE DR, SUITE 1
SCRANTON, PA 18508
Lackawanna County (570) 702-8700
DR. CHARLES THOMAS GRAD SR. MD
Internal Medicine
201 SMALLACOMBE DR
SCRANTON, PA 18508
Lackawanna County (570) 961-0171
VIOLETA MARINA LIZANO M.D.
Pediatrics
201 SMALLACOMBE DR
SCRANTON, PA 18508
Lackawanna County (570) 961-0171
JILLIAN DWYER PHARMD, CGP
Pharmacist
201 SMALLACOMBE DR
SCRANTON, PA 18508
Lackawanna County (570) 702-8700
KEVIN E. BOWMAN PHARM.D.
Pharmacist (Geriatric)
201 SMALLACOMBE DR, SUITE#1
SCRANTON, PA 18508
Lackawanna County (570) 340-6450
THERESA GERMANO
Nurse Practitioner (Family)
201 SMALLACOMBE DR
SCRANTON, PA 18508
Lackawanna County (570) 961-0171
FRANK ANGELO MILANI M.D.
Nuclear Medicine (Nuclear Cardiology)
201 SMALLACOMBE DR
SCRANTON, PA 18508
Lackawanna County (570) 961-0171

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lackawanna Medical Group PC's NPI number?

The NPI number for Lackawanna Medical Group PC is 1770650962. It was assigned to this organization in the NPPES registry on November 30, 2006.

Where is Lackawanna Medical Group PC located?

Lackawanna Medical Group PC is located at 201 Smallacombe Dr, Scranton, PA 18508. The listed phone number is (570) 961-0171.

What is Lackawanna Medical Group PC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Lackawanna Medical Group PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 39D0927570) is associated with this NPI, valid through April 22, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lackawanna Medical Group PC was last updated on March 3, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.