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Organization
WELLSPAN MEDICAL GROUP
Active
Organization
WELLSPAN MEDICAL GROUP
Active
Other names
WellSpan Family Medicine - Wheatlyn
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TINA VEST (CREDENTIALING SUPERVISOR)
(717) 851-6928
Entity
Organization
Contact information
Practice address
235 ROSEDALE DR, MANCHESTER, PA 17345-1022
(717) 812-5229
(717) 266-7453
Mailing address
1803 MOUNT ROSE AVE, SUITE B3, YORK, PA 17403-3051
(717) 851-1405
(717) 266-7453
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0083498001
AMERIHEALTH 65 PA
PA
01
—
03058800
CAPITAL BLUE CROSS
PA
05
—
1007721360087
—
PA
01
—
1142444
AMERIHEALTH MERCY
PA
01
—
142576
HIGHMARK BLUE SHIELD
PA
01
—
1519817
GATEWAY
PA
01
—
5525074
AETNA
PA
01
—
800174
JOHN HOPKINS
PA
01
—
82198
UNISON
PA
01
—
CA3246
RAILROAD MEDICARE
PA
01
—
KX10
CAREFIRST MD BCBS
MD
01
—
S1E4
GEISINGER
PA
Enumeration date
12/01/2006
Last updated
09/11/2018
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