MEDICARE: WELLSPAN MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	CA3246	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1886854	OTHER	PA	HIGHMARK
3	20FQ	OTHER	MD	CAREFIRST BC/BS
4	418T	OTHER	PA	GEISINGER
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	2753686000	OTHER	PA	AMERIHEALTH 65PA
7	7176837	OTHER	PA	GATEWAY
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	20054026	OTHER	PA	AMERIHEALTH MERCY WMG
11	50060981	OTHER	PA	CAPITAL BLUE CROSS
12	7191896	OTHER	PA	AETNA
13	800174	OTHER	PA	JOHN HOPKINS

General Provider Information

NPI Number	:	1194819193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPAN MEDICAL GROUP

Provider Business Mailing Address
First Line	:	601 MEMORY LN
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-2231
Country	:	US
Telephone Number	:	717-851-1405
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 SAINT CHARLES WAY
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-4644
Country	:	US
Telephone Number	:	717-747-9911
Fax Number	:	717-741-3598

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	JENNIFER SWEITZER
Credential	:
Telephone Number	:	717-851-6838

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	01/16/2026

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Directions to “WELLSPAN MEDICAL GROUP ” Practice Location

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