Individual provider Active NPI

Marni Elizabeth Vought, PA-C

  • Medical Physician Assistant
  • Lebanon, PA
National Provider Identifier
1104651009
Registry record updated Apr 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA065892 Issued in PA
Practice address
956 Isabel Dr
Lebanon, PA 17042-7482
Phone
(717) 639-2255
NPI assigned
Sep 3, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 9, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA065892 PA Primary

Addresses

Primary practice location

956 Isabel Dr
Lebanon, PA 17042-7482

Mailing address

601 Memory LN
York, PA 17402-2231

Other practice location 1

1400 S Forge Rd
Palmyra, PA 17078-9519
Phone (717) 639-2255

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241112000343 PA Practitioner - Physician Assistant 8527592765 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Philadelphia College of Osteopathic Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellspan Medical GroupGroup PAC ID 1951213115, 2,438 clinicians

Practice addresses (Care Compare)

1400 S Forge Rd
Palmyra, PA 17078-9519

25 Monument Rd
York, PA 17403-5073

2618 E Market St
Autumn House
York, PA 17403
Phone (717) 845-7214

914 W Market St
Autumn House West
York, PA 17403
Phone (717) 845-7214

954 Isabel Dr
Lebanon, PA 17042-7482
Phone (717) 273-6937

956 Isabel Dr
Lebanon, PA 17042-7482
Phone (717) 639-3640

958 Isabel Dr
Lebanon, PA 17042-7482
Phone (717) 639-2978

Hospital & facility affiliations

  • Wellspan Good Samaritan Hospital Hospital, Lebanon, PA, CCN 390066
  • Wellspan Ephrata Community Hospital Hospital, Ephrata, PA, CCN 390225

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA065892PAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group CurrentSince Sep 1, 2024 Accepting new patients
Wellspan Medical Group CurrentSince Sep 1, 2024 Accepting new patients
Wellspan Medical Group Past Accepting new patients

Locations

956 Isabel Dr
North Cornwall, PA 17042
Phone (717) 272-4104

1400 S Forge Rd
Palmyra, PA 17078
Phone (717) 274-5500

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

1600 S George St
York, PA 17403
Phone (717) 848-3615

601 Memory Ln
York, PA 17402
Phone (717) 851-6670

Interoperability endpoints

  • Direct secure messaging: mgranzow444395@wellspan.direct-ci.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775692800000",
    "number": "1104651009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MEMORY LN",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174022231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "956 ISABEL DR",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427482",
            "telephone_number": "717-639-2255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 S Forge Rd",
            "address_purpose": "LOCATION",
            "city": "Palmyra",
            "state": "PA",
            "postal_code": "170789519",
            "country_code": "US",
            "telephone_number": "717-639-2255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VOUGHT",
        "first_name": "MARNI",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-03",
        "last_updated": "2026-04-09",
        "certification_date": "2026-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA065892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, PA

Sources for this page

Verify at the official NPI Registry.