MEDICARE: WELLSPAN MEDICAL GROUP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician
2	2084N0600X	Clinical Neurophysiology Physician
3	363L00000X	Nurse Practitioner
4	2084N0400X	Neurology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	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	032240400	OTHER	PA	CAPITAL BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	800174	OTHER	PA	JOHN HOPKINS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1523767	OTHER	PA	GATEWAY
7	20013275	OTHER	PA	AMERIHEALTH MERCY
8	7465868	OTHER	PA	AETNA
10	KBE4	OTHER	MD	CAREFIRST BCBS
11	1341685	OTHER	PA	HIGHMARK BLUE SHIELD
12	337T	OTHER	PA	GEISINGER

General Provider Information

NPI Number	:	1831251792
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	:	717-851-5503
Fax Number	:	717-851-5507

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	11/11/2025

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