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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
3400 SPRUCE ST, 8 RAVDIN, PHILADELPHIA, PA 19104-4206
(215) 662-3228
(215) 349-8831
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
—
—
208000000X
Pediatrics Physician
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
—
2080P0202X
Pediatric Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0794792000
KEYSTONE
PA
05
—
1001258770
—
PA
01
—
1013506
KEYSTONE MERCY
PA
01
—
12502
HEALTHPARTNERS
PA
01
—
2Y22674
HEATLHNET
PA
01
—
502554
AETNA
PA
01
—
706905
BLUE SHIELD
PA
05
—
7160402
—
NJ
01
—
CI1503
RAILROAD MEDICARE
PA
Enumeration date
09/08/2006
Last updated
06/09/2008
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