Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Other names
SPS-Infectious Disease/NP
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES SANTANGELO (EXECUTIVE VP AND CFO)
(570) 321-3171
Entity
Organization
Contact information
Practice address
777 RURAL AVE, WILLIAMSPORT, PA 17701-3145
(570) 321-2181
(570) 321-2182
Mailing address
1201 GRAMPIAN BLVD, PO BOX 3127, WILLIAMSPORT, PA 17701-0127
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017300760168
—
PA
01
—
1998728
HIGHMARK BLUE SHIELD
PA
Enumeration date
10/09/2007
Last updated
06/02/2009
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