Organization
WELLSPAN MEDICAL GROUP
Active
Other names
York 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
2050 S QUEEN ST, SUITE 100, YORK, PA 17403-4829
(717) 812-4240
(717) 848-5520
Mailing address
1803 MOUNT ROSE AVE, SUITE B3, YORK, PA 17403-3051
(717) 851-1405
(717) 846-8185
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0068581001
AMERIH65PA-QUEEN ST
PA
01
—
0068581003
AMERIH65PA-CARLISLE RD
PA
01
—
03124100
CAPITAL BLUE CROSS
PA
05
—
1007721360090
—
PA
05
—
1007721360101
—
PA
01
—
1142399
AMERIH MERCY-QUEEN ST
PA
01
—
1519311
GATEWAY-QUEEN ST
PA
01
—
1519312
GATEWAY-CARLISLE RD
PA
01
—
20005265
AMERIH MERCY-CARLISLE RD
PA
01
—
4509645
AETNA
PA
01
—
455070
HIGHMARK BLUE SHIELD
PA
01
—
800174
JOHN HOPKINS
PA
01
—
82152
UNISON
PA
01
—
CA3246
RAILROAD MEDICARE
PA
01
—
KX53
CAREFIRST MD BCBS
MD
01
—
S1E5
GEISINGER
PA
Enumeration date
12/12/2006
Last updated
12/23/2015
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