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General NPI Number Information
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NPI Number | 1174752539
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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 | 07/07/2009
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 10 MUDDY CREEK FORKS RD STE 3
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City | BROGUE
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State | PA
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Zip | 17309-9400
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Country | US
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Telephone | 717-812-5020
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Fax | 717-461-7144
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Provider Business Mailing Address
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Address Line | 601 MEMORY LN
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City | YORK
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State | PA
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Zip | 17402-2231
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Country | US
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Telephone | 717-851-1405
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Fax |
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Authorized Official
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Title or Position | DIRECTOR- PFS
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Name | JENNIFER SWEITZER
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Credential |
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Telephone | 717-851-6838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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