Provider Demographics
NPI:1629139621
Name:WELLSPAN MEDICAL GROUP
Entity type:Organization
Organization Name:WELLSPAN MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND AO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-851-6838
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:2050 S QUEEN ST
Practice Address - Street 2:STE 200
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4829
Practice Address - Country:US
Practice Address - Phone:717-812-2316
Practice Address - Fax:717-848-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4473686OtherAETNA
PA1007721360096Medicaid
PA1007721360112Medicaid
PA1142781OtherAMERIHEALTH MERCY
PA0068402000OtherAMERIHEALTH 65PA
PA1007721360098Medicaid
PA82325OtherUNISON
PA800174OtherJOHN HOPKINS
PA1007721360115Medicaid
PA1519820OtherGATEWAY
PACA3246OtherRAILROAD MEDICARE
MDKX03OtherCAREFIRST
PA028645OtherHIGHMARK BLUE SHIELD
PA03007400OtherCAPITAL BLUE CROSS
PA03007400OtherCAPITAL BLUE CROSS
PA=========073OtherTRICARE QUEEN ST
PA1519820OtherGATEWAY
PA=========017OtherTRICARE LINCOLN HWY
PA=========100OtherTRICARE WOLFE ROAD
PA=========073OtherTRICARE QUEEN ST