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	363A00000X	Physician Assistant
2	207Q00000X	Family Medicine Physician

Medicare Identifiers

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82212	OTHER	PA	UNISON
2	02293300	OTHER	PA	CAPITAL BLUE CROSS
4	0756905001	OTHER	PA	AMERIHEALTH 65 PA
5	800174	OTHER	PA	JOHN HOPKINS
6	KX10	OTHER	MD	CAREFIRST MD BCBS
7	1519296	OTHER	PA	GATEWAY
8	S1ER	OTHER	PA	GEISINGER
9	1142342	OTHER	PA	AMERIHEALTH MERCY
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	5388041	OTHER	PA	AETNA
12	597344	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1649348525
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	:	105 4TH ST # 727
Second Line	:
City	:	EAST BERLIN
State	:	PA
Zip	:	17316-9638
Country	:	US
Telephone Number	:	717-812-4900
Fax Number	:	717-255-0951

Authorized Official
Title or Position	:	DIRECTOR PATIENT FINANCIAL SERVICES
Name	:	MS. JENNIFER SWEITZER
Credential	:
Telephone Number	:	717-851-6838

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	06/06/2025

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Directions to “WELLSPAN MEDICAL GROUP ” Practice Location

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