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General NPI Number Information
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NPI Number | 1790315653
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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 | 01/20/2020
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 25 MONUMENT RD STE 297
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City | YORK
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State | PA
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Zip | 17403-5049
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Country | US
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Telephone | 717-741-6732
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Fax | 717-740-6058
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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 | 717-851-1405
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Fax | 717-851-6969
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | LAURA FRANK
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Credential |
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Telephone | 717-851-6832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology 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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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