# WELLSPAN MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WELLSPAN FAMILY MEDICINE-BALTIMORE ST
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184962821
- **Authorized official:** MS. LAURA FRANK (CREDENTIALING SUPERVISOR)
- **Authorized official phone:** (717) 851-1405

## Contact information

- **Practice address:** 1227 BALTIMORE ST, HANOVER, PA 17331-4406
- **Practice address phone:** (717) 812-5190
- **Practice address fax:** (717) 637-2245
- **Mailing address:** 1803 MOUNT ROSE AVE STE B3, YORK, PA 17403-3051
- **Mailing address phone:** (717) 851-1405
- **Mailing address fax:** (717) 637-2245

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171100000X | Acupuncturist | — | NULL | — |
| 171100000X | Acupuncturist | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/30/2013
- **Last updated:** 05/19/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1545712 | GATEWAY HEALTH PLAN | PA |
| 01 | — | 2800588 | HIGHMARK BLUE SHIELD | PA |
| 01 | — | 30142128 | AMERIHEALTH MERCY - WMG | PA |
| 01 | — | 50115587 | CAPITAL BLUE CROSS - WMG | PA |
| 01 | — | 9172984 | AETNA | PA |