Basic Information
| Provider Information | |||||||||
| NPI: | 1609112036 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YORK HOSPITAL | ||||||||
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| OtherOrganizationName: | WELLSPAN YORK HOSPITAL OB/GYN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7177096529 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 EDGAR ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174032862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178124602 | ||||||||
| FaxNumber: | 7178123499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2012 | ||||||||
| LastUpdateDate: | 09/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | DIAMOND | ||||||||
| AuthorizedOfficialFirstName: | VICTORIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 7178513464 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | PA | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 367A00000X | PA | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 207V00000X | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1615499 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | 9043928 | 01 | PA | AETNA HEALTH PLAN | OTHER | 2762397 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 100196547 | 05 | PA | MEDICAID | 50113793 | 01 | PA | CAPITAL BLUE CROSS - WMG | OTHER |