Provider Demographics
NPI:1578623781
Name:WELLSPAN MEDICAL GROUP
Entity Type:Organization
Organization Name:WELLSPAN MEDICAL GROUP
Other - Org Name:WELLSPAN ENDOCRINOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR AND AO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-851-6838
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:292 SAINT CHARLES WAY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4648
Practice Address - Country:US
Practice Address - Phone:717-851-6231
Practice Address - Fax:717-851-5978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA596394OtherHIGHMARK BLUE SHIELD
PA343TOtherGEISINGER
PA02307500OtherCAPITAL BLUE CROSS
PA1519834OtherGATEWAY
PA93808OtherUNISON
MDKY96OtherCAREFIRST BCBS
PA800174OtherJOHN HOPKINS
PA1007721360081Medicaid
PA1007721360236Medicaid
PA7853906OtherAETNA
PACA3246OtherRAILROAD MEDICARE
PA075641000OtherAMERIHEALTH 65PA
PA114805OtherAMERIHEALTH MERCY
PA114805OtherAMERIHEALTH MERCY
PA343TOtherGEISINGER
PA596394OtherHIGHMARK BLUE SHIELD