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General NPI Number Information
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NPI Number | 1568884351
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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 | 01/13/2014
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Last Update Date | 05/05/2014
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Provider Practice Location Address
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Address Line | 2050 S QUEEN ST
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City | YORK
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State | PA
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Zip | 17403-4829
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Country | US
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Telephone | 717-851-1990
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Fax | 717-848-5540
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Provider Business Mailing Address
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Address Line | 3421 CONCORD RD
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City | YORK
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State | PA
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Zip | 17402-9001
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Country | US
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Telephone | 717-851-1990
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Fax | 717-848-5540
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | MS. AMY F WILKINSON
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology 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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine 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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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