WELLSPAN FAMILY MEDICINE - WEST CORNWALL
NPI 1639620164
Family Medicine in Lebanon, PA

Q: What is Wellspan Medical Group's NPI number?

The NPI number for Wellspan Medical Group is 1639620164. It was assigned to this organization in the NPPES registry on October 19, 2016. The provider is doing business as Wellspan Family Medicine - West Cornwall.

Q: What is Wellspan Medical Group's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since October 19, 2016CLIA 39D0958599 · Waiver

101 FAIRVIEW CIR, LEBANON, PA 17042(717) 279-7303(717) 279-7471 Get Directions Write a Review

NPPES record last updated: October 20, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Wellspan Family Medicine - West Cornwall NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WELLSPAN FAMILY MEDICINE - WEST CORNWALL (NPI 1639620164) is a healthcare organization registered as a family medicine in Lebanon, Pennsylvania and active in the NPI registry since October 2016. The organization holds a CLIA Waiver certificate valid through May 30, 2028 and lists Christina Moon, Supervisor-verification Services, as its authorized official.

NPPES Registry Identity

NPI1639620164

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameWELLSPAN MEDICAL GROUP

Location Address101 FAIRVIEW CIRLebanon, PA 17042-9581

Mailing Address3421 Concord RdYork, PA 17402-9001 · (717) 851-1405 · Fax (717) 851-6969

Phone(717) 279-7303

Fax(717) 279-7471

Organization SubpartNo

Authorized OfficialChristina MoonSupervisor-verification Services · (717) 851-1405

Enumeration DateOctober 19, 2016

Last NPPES UpdateOctober 20, 2016

✔ NPI 1639620164 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

101 FAIRVIEW CIR, Lebanon, PA 17042

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Other Names 1

Doing Business AsWellspan Family Medicine - West Cornwall

Other Identifiers 1

Medicare PIN117038FLTPA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 39D0958599

Wellspan Fam Med West Cornwall · Lebanon, PA

Active · expires May 30, 2028

CLIA Number39D0958599

Laboratory TypePhysician Office

Certificate Effective DateMay 31, 2026

Certificate Expiration DateMay 30, 2028

Laboratory DirectorDr. Joseph J. Walden

Laboratory Phone(717) 279-7303

Laboratory LocationWellspan Fam Med West Cornwall101 Fairview Circle, Lebanon, PA 17042

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AMY ELIZABETH BROSE PA-C

Physician Assistant (Medical)