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
(610) 902-2040
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
207ZB0001X
Blood Banking & Transfusion Medicine Physician
—
PA
207ZC0500X
Cytopathology Physician
—
PA
207ZD0900X
Dermatopathology (Pathology) Physician
—
PA
207ZF0201X
Forensic Pathology Physician
—
PA
207ZI0100X
Immunopathology Physician
—
PA
207ZM0300X
Medical Microbiology Physician
—
PA
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
—
PA
207ZP0101X
Anatomic Pathology Physician
Primary
—
PA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
PA
207ZP0104X
Chemical Pathology Physician
—
PA
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0170486000
KEYSTONE
PA
05
—
1001258770
—
PA
01
—
1038539
MERCY
PA
01
—
184052
BLUE SHIELD
PA
01
—
25325
HEALTHPARTNERS
PA
01
—
273379
MAMSI
PA
01
—
300654
EEIOC
PA
01
—
710842
AETNA
PA
01
—
7537000
NJ-MEDICAID
NJ
01
—
CN3127
RR MEDICARE
PA
01
—
E98600
AMERICHOICE
PA
Enumeration date
08/21/2006
Last updated
09/11/2025
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