Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Other names
SPS-Neurology
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES SANTANGELO (EXECUTIVE VP/CFO)
(570) 321-3171
Entity
Organization
Contact information
Practice address
700 HIGH STREET, WILLIAMSPORT, PA 17701-3198
(570) 321-2820
(570) 321-2821
Mailing address
PO BOX 3127, 1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-0127
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017300760176
—
PA
01
—
1603595
HIGHMARK BLUE SHIELD
PA
01
—
50054352
CAPITAL BLUECROSS
PA
Enumeration date
07/07/2006
Last updated
02/22/2012
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