Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Other names
Susquehanna Health Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELISSA DAVIS (VP/COO)
(570) 320-7696
Entity
Organization
Contact information
Practice address
740 HIGH STREET, SUITE 1004, WILLIAMSPORT, PA 17701-3100
(570) 321-3300
(570) 321-3301
Mailing address
1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-1900
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017300760173
—
PA
01
—
2104850
HIGHMARK BLUE SHIELD
PA
Enumeration date
06/03/2009
Last updated
10/22/2015
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