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Organization
WELLSPAN MEDICAL GROUP
Active
Organization
WELLSPAN MEDICAL GROUP
Active
Other names
WELLSPAN FAMILY MEDICINE - STONY BROOK
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTINA VEST (CREDENTIALING SUPERVISOR)
(717) 851-1405
Entity
Organization
Contact information
Practice address
4222 LINCOLN HWY, YORK, PA 17406-8083
(717) 812-2050
(717) 812-2052
Mailing address
1803 MOUNT ROSE AVE, SUITE B3, YORK, PA 17403-3051
(717) 851-1405
(717) 812-2052
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02314700
CAPITAL BLUE CROSS
PA
01
—
0756904001
AMERIHEALTH 65 PA
PA
05
—
1007721360117
—
PA
01
—
1142436
AMERIHEALTH MERCY
PA
01
—
1519297
GATEWAY
PA
01
—
597333
HIGHMARK BLUE SHIELD
PA
01
—
800174
JOHN HOPKINS
PA
01
—
82195
UNISON
PA
01
—
CA3246
RAILROAD MEDICARE
PA
01
—
KX10
CAREFIRST MD BCBS
MD
01
—
S1E2
GEISINGER
PA
Enumeration date
11/30/2006
Last updated
01/11/2018
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