# WELLSPAN MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WELLSPAN FAMILY MEDICINE - LITTLESTOWN
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770651804
- **Authorized official:** MS. CHRISTINA VEST (CREDENTIALING SUPERVISOR)
- **Authorized official phone:** (717) 851-1405

## Contact information

- **Practice address:** 300 W KING ST, SUITE C, LITTLESTOWN, PA 17340-1446
- **Practice address phone:** (717) 339-2390
- **Practice address fax:** (717) 359-4178
- **Mailing address:** 1803 MOUNT ROSE AVE, SUITE B3, YORK, PA 17403-3051
- **Mailing address phone:** (717) 851-1405
- **Mailing address fax:** (717) 359-4178

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/30/2006
- **Last updated:** 01/11/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1007721360251 | — | PA |
| 01 | — | 1552819 | GATEWAY | PA |
| 01 | — | 183123 | UNISON | PA |
| 01 | — | 1848156 | HIGHMARK BLUE SHIELD | PA |
| 01 | — | 20051562 | AMERIHEALTH MERCY | PA |
| 01 | — | 2706111001 | AMERIHEALTH 65 PA | PA |
| 01 | — | 50059430 | CAPITAL BLUE CROSS | PA |
| 01 | — | 7015846 | AETNA | PA |
| 01 | — | 800174 | JOHN HOPKINS | PA |
| 01 | — | CA3246 | RAILROAD MEDICARE | PA |
| 01 | — | KX10 | CAREFIRST MD BCBS | MD |
| 01 | — | S1EX | GEISINGER | PA |