Organization
UNIVERSITY OF PENN - MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY GRECO (PAYER ENROLLMENT MANAGER)
(223) 341-8516
Entity
Organization
Contact information
Practice address
3400 SPRUCE ST, 3 RAVDIN, SUITE F, PULMONARY & CRITICAL CARE, PHILADELPHIA, PA 19104-4206
(215) 662-3202
Mailing address
3400 SPRUCE ST, 3 RAVDIN - SUITE F, PHILADELPHIA, PA 19104-4206
(215) 662-3202
(215) 349-8432
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006610360
—
PA
01
—
002Y20116
HEALTHNET
PA
01
—
0193436000
KEYSTONE
PA
01
—
020255499
EEIOC
PA
01
—
043063
BLUE SHIELD
PA
01
—
06632
HEALTHPARTNERS
PA
01
—
1010943
MERCY
PA
01
—
273248
MAMSI
PA
01
—
495710
AETNA
PA
01
—
5469406
NJ-MEDICAID
NJ
01
—
CA0235
RR MEDICARE
PA
01
—
G00031670
AMERICHOICE
PA
Enumeration date
08/25/2006
Last updated
07/31/2025
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