MEDICARE: WELLSPAN MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician

General Provider Information

NPI Number	:	1790195576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPAN MEDICAL GROUP

Provider Business Mailing Address
First Line	:	601 MEMORY LN
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-2231
Country	:	US
Telephone Number	:	717-851-1405
Fax Number	:	717-851-6969

Provider Business Practice Location Address
First Line	:	450 S WASHINGTON ST
Second Line	:	SUITE E
City	:	GETTYSBURG
State	:	PA
Zip	:	17325-2500
Country	:	US
Telephone Number	:	717-851-1405
Fax Number	:	717-851-6969

Authorized Official
Title or Position	:	DIRECTOR AND AO
Name	:	JENNIFER SWEITZER
Credential	:
Telephone Number	:	717-851-6838

Provider Enumeration Date	:	05/02/2014
Last Update Date	:	12/18/2025

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Directions to “WELLSPAN MEDICAL GROUP ” Practice Location

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