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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
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0281862000
KEYSTONE
PA
05
—
1001258770
—
PA
01
—
1038420
MERCY
PA
01
—
20753
HEALTHPARTNERS
PA
01
—
2Y21509
HEALTHNET
PA
01
—
674378
BLUE SHIELD
PA
01
—
707792
AETNA
PA
01
—
CN3127
RR MEDICARE
PA
Enumeration date
08/25/2006
Last updated
05/08/2008
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