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Organization
UNIVERSITY OF PENN - PA ER
Active
Organization
UNIVERSITY OF PENN - PA ER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH JOHNSTON (EXECUTIVE DIRECTOR)
(215) 662-7583
Entity
Organization
Contact information
Practice address
3400 SPRUCE ST, GROUND SILVERSTEIN BLDG, PHILADELPHIA, PA 19104-4206
(215) 662-6963
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
2083X0100X
Occupational Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015839360041
—
PA
01
—
089398
BLUE SHIELD
PA
Enumeration date
07/04/2006
Last updated
10/22/2012
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