# SUSQUEHANNA PHYSICIAN SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SPS-Allergy & Immunology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013118389
- **Authorized official:** MR. CHARLES SANTANGELO (EXECUTIVE VP AND CFO)
- **Authorized official phone:** (570) 321-3171

## Contact information

- **Practice address:** 1705 WARREN AVE, SUITE 201, WILLIAMSPORT, PA 17701-2664
- **Practice address phone:** (570) 320-7645
- **Practice address fax:** (570) 320-7646
- **Mailing address:** 1201 GRAMPIAN BLVD, PO BOX 3127, WILLIAMSPORT, PA 17701-0127

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | — | NULL | Yes |
| 207K00000X | Allergy & Immunology Physician | — | — | Yes |
| 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