| Organization Name: | SUSQUEHANNA PHYSICIAN SERVICES |
| NPI Number: | 1013118389 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES SANTANGELO (EXECUTIVE VP AND CFO) |
| Mailing Address: | 1705 Warren Ave Suite 201 Williamsport |
| State: | PA US |
| Postal Code: | 177012664 |
| Phone Number: | 5703207645 |
| Fax Number: | 5703207646 |
| NPI Enumeration Date: | 05/31/2007 |
| NPI Last Update Date: | 05/20/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2080P0201X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Pediatrics |
| Taxonomy Specialization: | Pediatric Allergy/Immunology |
| Taxonomy Definition: | A pediatrician who specializes in the diagnosis and treatment of allergies, allergic reactions, and immunologic diseases in children. |