Organization
WELLSPAN MEDICAL GROUP
Active
Organization
WELLSPAN MEDICAL GROUP
Active
Other names
Wellspan Surgical Oncology
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMY F WILKINSON (CREDENTIALING SUPERVISOR)
(717) 851-1405
Entity
Organization
Contact information
Practice address
25 MONUMENT RD, SUITE 220, YORK, PA 17403-5049
(717) 812-7676
(717) 812-5176
Mailing address
1803 MOUNT ROSE AVE, SUITE B3, YORK, PA 17403-3026
(717) 851-1405
(717) 741-8217
Taxonomy
Speciality
Code
Description
License number
State
2086X0206X
Surgical Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100772136
—
PA
01
—
1578610
GATEWAY-WMG
PA
01
—
20082423
AMERIHEALTH MERCY-WMG
PA
01
—
2086650
HIGHMARK BLUE SHIELD
PA
01
—
261028
UNISON-WMG
PA
01
—
50083176
CAPITAL BLUE CROSS-WMG
PA
01
—
9095312
AETNA
PA
01
—
F0WKWE
CAREFIRST MD BCBS
MD
Enumeration date
01/22/2009
Last updated
12/31/2015
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