Provider Demographics
NPI:1821159021
Name:WELLSPAN MEDICAL GROUP
Entity type:Organization
Organization Name:WELLSPAN MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND AO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELAINE
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 1:380 SAINT CHARLES WAY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4647
Practice Address - Country:US
Practice Address - Phone:717-851-6040
Practice Address - Fax:717-812-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20047687OtherAMERIHEALTH MERCY
MD522COtherCAREFIRST BCBS
PA7579839OtherAETNA
PA50055987OtherCAPITAL BLUE CROSS
PA0667146000OtherAMERIHEALTH 65PA
PA340TOtherGEISINGER
PA800174OtherJOHN HOPKINS
PA117038OtherHIGHMARK BLUES SHIELD
PA1548225OtherGATEWAY
PACA3246OtherRAILROAD MEDICARE
PA1007721360254Medicaid
PA800174OtherJOHN HOPKINS
PA1007721360254Medicaid