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Organization
TRUSTEES OF THE UNIV OF PA
Active
Organization
TRUSTEES OF THE UNIV OF PA
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
—
—
207RN0300X
Nephrology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006610360
—
PA
01
—
0176009000
KEYSTONE
PA
01
—
1010964
MERCY
PA
01
—
140770
BLUE SHIELD
PA
01
—
28453
HEALTHPARTNERS
PA
01
—
2Y20116
HEALTHNET
PA
01
—
496714
AETNA
PA
01
—
CN3127
RR MEDICARE
PA
Enumeration date
08/25/2006
Last updated
05/12/2008
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