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Organization
WELLSPAN MEDICAL GROUP
Active
Organization
WELLSPAN MEDICAL GROUP
Active
Other names
WELLSPAN FAMILY MEDICINE - FREDERICK ST
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTINA VEST (CREDENTIALING SUPERVISOR)
(717) 851-1405
Entity
Organization
Contact information
Practice address
100 FREDERICK ST, SUITE 101, HANOVER, PA 17331-3518
(717) 851-7050
(717) 632-7478
Mailing address
1803 MOUNT ROSE AVE, SUITE B3, YORK, PA 17403-3026
(717) 851-6816
(717) 632-7478
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1603334
GATEWAY HEALTH PLAN
PA
01
—
2695421
HIGHMARK BLUE SHIELD
PA
01
—
30112625
AMERIHEALTH MERCY - WMG
PA
01
—
50107968
CAPITAL BLUE CROSS - WMG
PA
01
—
9886818
AETNA
PA
Enumeration date
03/15/2012
Last updated
01/11/2018
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