Organization
UNIVERSITY OF PENN - DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH JOHNSTON (ENROLLMENT COORDINATOR)
(215) 662-7583
Entity
Organization
Contact information
Practice address
3400 SPRUCE ST, 2 RHOADS, PHILADELPHIA, PA 19104-4206
(215) 662-2737
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007486690
—
PA
01
—
1024157
KEYSTONE MERCY
PA
01
—
1117604
AETNA
PA
01
—
14945
HEALTHPARTNERS
PA
01
—
2214380000
KEYSTONE
PA
01
—
80939
BLUE SHIELD
PA
01
—
CA5541
RAILROAD MEDICARE
PA
Enumeration date
03/07/2007
Last updated
04/12/2013
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