Susquehanna Physician Services
Family Medicine in Williamsport, PA. Organization (NPI-2).
NPI number1013963370
StatusActive
Last updated in NPPESOct 20, 2015
Details
- NPI
- 1013963370
- Entity type
- Organization (NPI-2)
- Legal business name
- Susquehanna Physician Services
- Organization subpart
- No
- Enumeration date
- May 26, 2006
- Last updated
- Oct 20, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
| 207VX0000X | Obstetrics & Gynecology, Obstetrics | – | – | |
| 363L00000X | Nurse Practitioner | – | – | |
| 363A00000X | Physician Assistant | – | – |
Other names
- Susquehanna Health Medical Group (Doing Business As)
Practice location
1705 Warren AveSuite 303
Williamsport, PA 17701-2665
Phone 570-326-8500 · Fax 570-326-8049
Mailing address
1201 Grampian BlvdWilliamsport, PA 17701-1900
Authorized official
Melissa Davis
Vp/Coo
5703207696
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