| Susquehanna Health Medical Group | |
|
700 High Street Williamsport PA 17701-3198 | |
| (570) 321-3454 | |
| (570) 321-3455 |
| Full Name | Susquehanna Health Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 700 High Street, Williamsport, Pennsylvania |
| Authorized Official Name and Position | Melissa Davis (VP/COO) |
| Authorized Official Contact | 5703207696 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Susquehanna Health Medical Group 1201 Grampian Blvd Williamsport PA 17701-1900 Ph: () - | Susquehanna Health Medical Group 700 High Street Williamsport PA 17701-3198 Ph: (570) 321-3454 |
| NPI Number | 1235366857 |
|---|---|
| Provider Enumeration Date | 06/22/2009 |
| Last Update Date | 10/23/2015 |
| Medicare PECOS PAC ID | 2264336460 |
|---|---|
| Medicare Enrollment ID | O20090909000479 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235366857 | NPI | - | NPPES |
| 2130352 | Other | PA | HIGHMARK BLUE SHIELD |
| 0017300760192 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| Provider Name | James J Boylan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538159546 PECOS PAC ID: 0446243927 Enrollment ID: I20040408000657 |
| Provider Name | Emily Theresa Suvock |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1750453239 PECOS PAC ID: 7618978735 Enrollment ID: I20070116000358 |
| Provider Name | Amit Sohagia |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1447456306 PECOS PAC ID: 5395832216 Enrollment ID: I20071024000534 |
| Provider Name | Stacy G Prall |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1437207685 PECOS PAC ID: 3173615069 Enrollment ID: I20100115000835 |
| Provider Name | Duane E Ahlbrandt |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1942289046 PECOS PAC ID: 0042284341 Enrollment ID: I20100513000873 |
| Provider Name | Heather J Gerst |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1114193299 PECOS PAC ID: 0244403939 Enrollment ID: I20111025000124 |
| Provider Name | Steven W Cohen |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1275608929 PECOS PAC ID: 4183880891 Enrollment ID: I20120725000300 |
| Provider Name | Vivek Kumar |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1427190461 PECOS PAC ID: 8224285234 Enrollment ID: I20120827000668 |
| Provider Name | Puneet S Basi |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1730343120 PECOS PAC ID: 8820247240 Enrollment ID: I20120928000505 |
| Provider Name | Anna Maryalice Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295320075 PECOS PAC ID: 1254747785 Enrollment ID: I20210309001113 |
| Provider Name | Lila Glotfelty |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1790102002 PECOS PAC ID: 0042511321 Enrollment ID: I20211111001045 |
| Provider Name | Ann Joo Lee |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396979126 PECOS PAC ID: 9739307638 Enrollment ID: I20211230001659 |
Susquehanna Health Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1705 Warren Ave, Suite 303, Williamsport, PA 17701 Phone: 570-326-8500 Fax: 570-326-8049 | |
Divine Providence Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 471 Hepburn St, Williamsport, PA 17701 Phone: 570-567-5400 Fax: 570-326-8601 | |
White Deer Run Of Williamsport Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 520 W 4th St, Williamsport, PA 17701 Phone: 570-322-4836 Fax: 570-322-4769 | |
Geisinger-hm Joint Venture, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1824 E 3rd St, Williamsport, PA 17701 Phone: 570-601-2200 Fax: 570-601-2202 | |
Susquehanna Health Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1100 Grampian Blvd, Williamsport, PA 17701 Phone: 570-320-7691 Fax: 570-320-7898 | |
Open Arms Internal Medicine & Pediatrics, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3155 Lycoming Creek Rd, Williamsport, PA 17701 Phone: 570-244-1877 | |
Sps-peck Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 904 Campbell St, Suite 202, Williamsport, PA 17701 Phone: 570-321-2290 Fax: 570-321-2289 |