Organization
WELLSPAN MEDICAL GROUP
Active
Other names
Springdale Pediatric Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMY F WILKINSON (CREDENTIALING COORDINATOR)
(717) 851-1405
Entity
Organization
Contact information
Practice address
2339 S GEORGE ST, YORK, PA 17403-5009
(717) 812-3040
(717) 812-3049
Mailing address
1803 MOUNT ROSE AVE, SUITE B3, YORK, PA 17403-3051
(717) 851-1405
(717) 812-3049
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0068573002
AMERIH65PA-RED LION
PA
01
—
0068573004
AMERIH65PA-GEORGE ST
PA
01
—
03058500
CAPITAL BLUE CROSS
PA
05
—
1007721360097
—
PA
05
—
1007721360104
—
PA
01
—
1142418
AMERIH MERCY-GEORGE ST
PA
01
—
147455
HIGHMARK BLUE SHIELD
PA
01
—
1519307
GATEWAY-WINDSOR RD
PA
01
—
1519308
GATEWAY-GEORGE STREET
PA
01
—
20011318
AMERIH MERCY-RED LION
PA
01
—
5643320
AETNA
PA
01
—
800174
JOHN HOPKINS
PA
01
—
82187
UNISON
PA
01
—
CA3246
RAILROAD MEDICARE
PA
01
—
KX53
CAREFIRST MD BCBS
MD
01
—
S1E0
GEISINGER
PA
Enumeration date
12/15/2006
Last updated
08/11/2010
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