Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Other names
Susquehanna Center for Liver Disease
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES SANTANGELO (EXECUTIVE VP/ CFO)
(570) 321-3171
Entity
Organization
Contact information
Practice address
471 HEPBURN ST, SUITE 135, WILLIAMSPORT, PA 17701-6122
(570) 567-5425
(570) 567-5426
Mailing address
1205 GRAMPIAN BLVD, PO BOX 3127, WILLIAMSPORT, PA 17701-1978
Taxonomy
Speciality
Code
Description
License number
State
207RI0008X
Hepatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1515700
HIGHMARK BLUE SHIELD
PA
Enumeration date
02/19/2007
Last updated
10/18/2007
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