Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
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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