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Organization
WELLSPAN MEDICAL GROUP
Active
Organization
WELLSPAN MEDICAL GROUP
Active
Other names
Brockie Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMY F WILKINSON (CREDENTIALING COORDINATOR)
(717) 851-1405
Entity
Organization
Contact information
Practice address
924 COLONIAL AVE STE B, YORK, PA 17403-3450
(717) 845-8623
(717) 843-6682
Mailing address
1803 MOUNT ROSE AVE, SUITE B3, YORK, PA 17403-3051
(717) 851-1405
(717) 843-6682
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0068498000
AMERI 65PA GEORGE ST
PA
01
—
0068498001
AMERI 65PA COLONIAL
PA
01
—
03005700
CAPITAL BLUE CROSS
PA
01
—
059784
HIGHMARK BLUE SHIELD
PA
05
—
100721360243
—
PA
05
—
1007721360092
—
PA
01
—
1142285
AMERIHEALTH COLONIAL AVE
PA
01
—
1519824
GATEWAY
PA
01
—
20010095
AMERIHEALTH GEORGE ST
PA
01
—
354T
GEISINGER SP
PA
01
—
5126007
AETNA
PA
01
—
800174
JOHN HOPKINS
PA
01
—
82194
UNISON COLONIAL AVE
PA
01
—
82201
UNISON GEORGE ST
PA
01
—
CA3246
RAILROAD MEDICARE
PA
01
—
DJ3Q
CAREFIRST MD BCBS
MD
01
—
S1EM
GEISINGER PCP
PA
Enumeration date
04/27/2006
Last updated
08/10/2010
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