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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
700 HIGH STREET, WILLIAMSPORT, PA 17701-3198
(570) 321-2400
(570) 321-2496
Mailing address
1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-1900

Taxonomy

Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
207UN0901X
Nuclear Cardiology Physician
2085N0904X
Nuclear Radiology Physician
2085R0202X
Diagnostic Radiology Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0017300760185
PA
01
887918
HIGHMARK BLUE SHIELD
PA
Enumeration date
07/07/2006
Last updated
11/16/2015
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