Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELISSA DAVIS (VP/COO)
(570) 320-7696
Entity
Organization
Contact information
Practice address
1100 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-1909
(570) 320-7525
(570) 320-7484
Mailing address
1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-1900
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
PA
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017300760154
—
PA
01
—
424132
HIGHMARK BLUE SHIELD
PA
Enumeration date
06/14/2006
Last updated
12/04/2017
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