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Organization
WELLSPAN MEDICAL GROUP
Active
Organization
WELLSPAN MEDICAL GROUP
Active
Other names
WELLSPAN FAMILY MEDICINE - DALLASTOWN
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTINA VEST (CREDENTIALING SUPERVISOR)
(717) 851-1405
Entity
Organization
Contact information
Practice address
755 S PLEASANT AVE, DALLASTOWN, PA 17313-9252
(717) 851-1300
(717) 851-1310
Mailing address
1803 MOUNT ROSE AVE, SUITE B3, YORK, PA 17403-3051
(717) 851-1405
(717) 851-1310
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0068835003
AMERIHEALTH 65 PA
PA
01
—
02297500
CAPITAL BLUE CROSS
PA
01
—
099048
HIGHMARK BLUE SHIELD
PA
05
—
1007721360085
—
PA
01
—
1142363
AMERIHEALTH MERCY
PA
01
—
1519304
GATEWAY
PA
01
—
5161031
AETNA
PA
01
—
800174
JOHN HOPKINS
PA
01
—
82148
UNISON
PA
01
—
CA3246
RAILROAD MEDICARE
PA
01
—
KX10
CAREFIRST MD BCBS
MD
01
—
S1EP
GEISINGER
PA
Enumeration date
12/01/2006
Last updated
01/11/2018
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