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General NPI Number Information
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NPI Number | 1013118389
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Entity Type | Organization
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Legal Business Name | SUSQUEHANNA PHYSICIAN SERVICES
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 1705 WARREN AVE SUITE 201
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-2664
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Country | US
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Telephone | 570-320-7645
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Fax | 570-320-7646
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Provider Business Mailing Address
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Address Line | 1201 GRAMPIAN BLVD PO BOX 3127
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-0127
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VP AND CFO
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Name | MR. CHARLES SANTANGELO
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Credential |
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Telephone | 570-321-3171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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