# TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750494332
- **Authorized official:** ELIZABETH JOHNSTON (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (215) 662-7583

## Contact information

- **Practice address:** 250 KING OF PRUSSIA RD, RADNOR, PA 19087-5220
- **Practice address phone:** (610) 902-2000
- **Mailing address:** 3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
- **Mailing address phone:** (215) 662-2286

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |
| 207RN0300X | Nephrology Physician | — | — | — |

## Other

- **Enumeration date:** 08/16/2006
- **Last updated:** 06/03/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0143087000 | KEYSTONE | PA |
| 05 | — | 1001258770 | — | PA |
| 01 | — | 20753 | HEALTHPARTNERS | PA |
| 01 | — | 2Y21509 | HEALTHNET | PA |
| 01 | — | 30007842 | MERCY | PA |
| 01 | — | 3269085 | AETNA | PA |
| 01 | — | 674378 | BLUE SHIELD | PA |
| 01 | — | CN3127 | RR MEDICARE | PA |