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
740 HIGH ST, SUITE 1003, WILLIAMSPORT, PA 17701-3100
(570) 321-3160
(570) 321-3161
Mailing address
1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-1900
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
—
—
208600000X
Surgery Physician
Primary
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017300760205
—
PA
Enumeration date
06/29/2006
Last updated
04/09/2020
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