Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Other names
SPS-Plastic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES SANTANGELO (EXECUTIVE VP/CFO)
(570) 321-3171
Entity
Organization
Contact information
Practice address
1201 GRAMPIAN BLVD, SUITE 1B, WILLIAMSPORT, PA 17701-1900
(570) 320-7570
(570) 320-7571
Mailing address
1205 GRAMPIAN BLVD, PO BOX 3127, WILLIAMSPORT, PA 17701-1978
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1743458
HIGHMARK BLUE SHIELD
PA
01
—
221536
FIRST PRIORITY HEALTH
PA
Enumeration date
07/19/2006
Last updated
10/18/2007
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