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	207RR0500X	Rheumatology Physician

Medicare Identifiers

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0756540000	OTHER	PA	AMERIHEALTH 65PA
2	50065210	OTHER	PA	CAPITAL BLUE CROSS
3	596384	OTHER	PA	HIGHMARK BLUE SHIELD
4	7235852	OTHER	PA	AETNA
5	800174	OTHER	PA	JOHN HOPKINS
6	124903	OTHER	PA	UNISON
7	1519844	OTHER	PA	GATEWAY
8	KY95	OTHER	MD	CAREFIRST BCBS
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	335T	OTHER	PA	GEISINGER
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	1142800	OTHER	PA	AMERIHEALTH MERCY

General Provider Information

NPI Number	:	1407916018
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	:	717-851-6969

Provider Business Practice Location Address
First Line	:	292 SAINT CHARLES WAY
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-4648
Country	:	US
Telephone Number	:	717-851-6236
Fax Number	:	717-851-6243

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	03/02/2026

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Directions to “WELLSPAN MEDICAL GROUP ” Practice Location

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