Provider Demographics
NPI:1629146709
Name:WELLSPAN MEDICAL GROUP
Entity Type:Organization
Organization Name:WELLSPAN MEDICAL GROUP
Other - Org Name:WELLSPAN FAMILY MEDICINE - STONEBRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER-CVS
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-851-1405
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:13515 WOLFE RD
Practice Address - Street 2:SUITE C
Practice Address - City:NEW FREEDOM
Practice Address - State:PA
Practice Address - Zip Code:17349-9346
Practice Address - Country:US
Practice Address - Phone:717-812-2501
Practice Address - Fax:717-461-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0756543002OtherAMERIHEALTH 65 PA
PA596398OtherHIGHMARK BLUE SHIELD
PA800174OtherJOHN HOPKINS
PA02298200OtherCAPITAL BLUE CROSS
PA1007721360114Medicaid
PA1519303OtherGATEWAY
PA5551045OtherAETNA
PA82204OtherUNISON
PA1142414OtherAMERIHEALTH MERCY
PACA3246OtherRAILROAD MEDICARE
MDKX10OtherCAREFIRST MD BCBS
PAS1E1OtherGEISINGER
PA5551045OtherAETNA
PACA3246OtherRAILROAD MEDICARE