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	207RN0300X	Nephrology Physician

Medicare Identifiers

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1548225	OTHER	PA	GATEWAY
3	0667146000	OTHER	PA	AMERIHEALTH 65PA
4	522C	OTHER	MD	CAREFIRST BCBS
5	7579839	OTHER	PA	AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	117038	OTHER	PA	HIGHMARK BLUES SHIELD
8	340T	OTHER	PA	GEISINGER
9	20047687	OTHER	PA	AMERIHEALTH MERCY
10	50055987	OTHER	PA	CAPITAL BLUE CROSS
11	800174	OTHER	PA	JOHN HOPKINS

General Provider Information

NPI Number	:	1821159021
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	:	380 SAINT CHARLES WAY
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-4647
Country	:	US
Telephone Number	:	717-851-6040
Fax Number	:	717-812-3190

Authorized Official
Title or Position	:	DIRECTOR AND AO
Name	:	JENNIFER ELAINE SWEITZER
Credential	:
Telephone Number	:	717-851-6838

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	12/09/2025

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Directions to “WELLSPAN MEDICAL GROUP ” Practice Location

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