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Organization
WELLSPAN MEDICAL GROUP
Active
Organization
WELLSPAN MEDICAL GROUP
Active
Other names
St. Charles Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMY F WILKINSON (CREDENTIALING COORDINATOR)
(717) 851-1405
Entity
Organization
Contact information
Practice address
296 ST. CHARLES WAY, YORK, PA 17402-4648
(717) 851-6567
(717) 851-6577
Mailing address
1803 MOUNT ROSE AVE, SUITE B3, YORK, PA 17403-3051
(717) 851-1405
(717) 851-6577
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021280001
AMERIHEALTH 65 PA
PA
01
—
02293500
CAPITAL BLUE CROSS
PA
05
—
1007721360132
—
PA
01
—
1142430
AMERIHEALTH MERCY
PA
01
—
1519314
GATEWAY
PA
01
—
369120
HIGHMARK BLUE SHIELD
PA
01
—
5894771
AETNA
PA
01
—
800174
JOHN HOPKINS
PA
01
—
84533
UNISON
PA
01
—
CA3246
RAILROAD MEDICARE
PA
01
—
KX54
CAREFIRST MD BCBS
MD
01
—
S1EZ
GEISINGER
PA
Enumeration date
12/05/2006
Last updated
08/11/2010
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