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Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELISSA DAVIS (VP/COO)
(570) 320-7696
Entity
Organization
Contact information
Practice address
1201 GRAMPIAN BLVD STE 1A, WILLIAMSPORT, PA 17701-1965
(570) 326-8080
(570) 326-2733
Mailing address
1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-1900
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017300760171
—
PA
01
—
2089118
HIGHMARK BLUE SHIELD
PA
Enumeration date
02/20/2009
Last updated
04/24/2020
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