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General NPI Number Information
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NPI Number | 1871198432
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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 | 12/02/2020
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 103 W 9TH ST
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City | BERWICK
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State | PA
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Zip | 18603-3024
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Country | US
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Telephone | 570-759-1363
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Fax | 570-759-2070
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Provider Business Mailing Address
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Address Line | 1201 GRAMPIAN BLVD
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1900
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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 | VP/COO
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Name | MELISSA DAVIS
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Credential |
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Telephone | 573-326-8544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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