Provider Demographics
NPI:1669770004
Name:WELLSPAN MEDICAL GROUP
Entity type:Organization
Organization Name:WELLSPAN MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR & 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 STE B3
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:
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8200
Practice Address - Country:US
Practice Address - Phone:717-812-5120
Practice Address - Fax:717-741-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30088992OtherAMERIHEALTH MERCY-WMG
PA9203695OtherAETNA-WMG
MDC8J5OtherCAREFIRST MD BCBS-WMG
PA2598649OtherHIGHMARK BLUE SHIELD-WMG
PA1593952OtherGATEWAY-WMG
PA1007721360299Medicaid
PA50099585OtherCAPITAL BLUE CROSS-WMG
PA117038FLTMedicare PIN