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General NPI Number Information
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NPI Number | 1124104245
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Entity Type | Organization
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Legal Business Name | WELLSPAN MEDICAL GROUP
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 01/11/2018
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Provider Practice Location Address
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Address Line | 1001 S GEORGE ST
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City | YORK
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State | PA
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Zip | 17403-3676
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Country | US
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Telephone | 717-851-3884
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Fax | 717-851-3382
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Provider Business Mailing Address
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Address Line | 1803 MOUNT ROSE AVE SUITE B3
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City | YORK
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State | PA
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Zip | 17403-3051
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Country | US
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Telephone | 717-851-1405
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Fax | 717-851-3382
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | MS. CHRISTINA VEST
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Credential |
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Telephone | 717-851-1405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) 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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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