Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Other names
Susquehanna Health Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELISSA DAVIS (VP/COO)
(570) 320-7696
Entity
Organization
Contact information
Practice address
1705 WARREN AVE, SUITE 204-205, WILLIAMSPORT, PA 17701-2647
(570) 320-7474
(570) 320-7479
Mailing address
1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-1900
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
231H00000X
Audiologist
—
—
237600000X
Audiologist-Hearing Aid Fitter
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017300760201
—
PA
05
—
0017300760202
—
PA
01
—
501737
HIGHMARK BLUE SHIELD
PA
Enumeration date
07/25/2006
Last updated
03/17/2018
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