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Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Other names
SPS-Allergy & Immunology
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES SANTANGELO (EXECUTIVE VP AND CFO)
(570) 321-3171
Entity
Organization
Contact information
Practice address
1705 WARREN AVE, SUITE 201, WILLIAMSPORT, PA 17701-2664
(570) 320-7645
(570) 320-7646
Mailing address
1201 GRAMPIAN BLVD, PO BOX 3127, WILLIAMSPORT, PA 17701-0127
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
NULL
207K00000X
Allergy & Immunology Physician
Primary
—
—
2080P0201X
Pediatric Allergy/Immunology Physician
—
NULL
2080P0201X
Pediatric Allergy/Immunology Physician
—
—
2080P0214X
Pediatric Pulmonology Physician
—
NULL
2080P0214X
Pediatric Pulmonology Physician
—
—
Other
Enumeration date
05/31/2007
Last updated
05/20/2010
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