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1407019466

NPI Code Detail

MEDICARE: WELLSPAN MEDICAL GROUP

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	208100000X	Physical Medicine & Rehabilitation Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9265277	OTHER	PA	AETNA
2	20080294	OTHER	PA	AMERIHEALTH MERCY-WMG
3	FGB5	OTHER	MD	CAREFIRST MD BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2063424	OTHER	PA	HIGHMARK BLUE SHIELD
6	249013	OTHER	PA	UNISON-WMG
7	363Y	OTHER	PA	GEISINGER HEALTH PLAN

General Provider Information

NPI Number	:	1407019466
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 STE 101
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-4661
Country	:	US
Telephone Number	:	717-812-2212
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SUPERVISOR
Name	:	MS. AMY F WILKINSON
Credential	:
Telephone Number	:	717-851-1405

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	04/23/2026

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Directions to “WELLSPAN MEDICAL GROUP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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