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Organization
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Active
Organization
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH JOHNSTON (EXECUTIVE DIRECTOR)
(215) 662-7583
Entity
Organization
Contact information
Practice address
250 KING OF PRUSSIA RD, RADNOR, PA 19087-5220
(610) 902-2000
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
PA
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
PA
207R00000X
Internal Medicine Physician
Primary
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0143087001
KEYSTONE
PA
01
—
096188
BLUE SHIELD
PA
05
—
1001258770
—
PA
01
—
1041746
MERCY
PA
01
—
18041
HEALTHPARTERNS
PA
01
—
2Y21509
HEALTHNET
PA
01
—
732227
AETNA
PA
05
—
8696501
—
NJ
01
—
CN3127
RR MEDICARE
PA
Enumeration date
08/21/2006
Last updated
06/03/2008
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