| Susquehanna Health Medical Group | |
|
1100 Grampian Blvd Williamsport PA 17701-1909 | |
| (570) 320-7525 | |
| (570) 320-7484 |
| Full Name | Susquehanna Health Medical Group |
|---|---|
| Speciality | Psychologist |
| Location | 1100 Grampian Blvd, Williamsport, Pennsylvania |
| Authorized Official Name and Position | Melissa Davis (VP/COO) |
| Authorized Official Contact | 5703207696 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Susquehanna Health Medical Group 1201 Grampian Blvd Williamsport PA 17701-1900 Ph: () - | Susquehanna Health Medical Group 1100 Grampian Blvd Williamsport PA 17701-1909 Ph: (570) 320-7525 |
| NPI Number | 1871512921 |
|---|---|
| Provider Enumeration Date | 07/19/2006 |
| Last Update Date | 11/24/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871512921 | NPI | - | NPPES |
| 0017300760150 | Medicaid | PA | |
| 220564 | Other | PA | FIRST PRIORITY HEALTH |
| 806756 | Other | PA | HIGHMARK BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Secondary |
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