Organization
UNIV OF PENN - REHAB MEDICINE
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, 1 GROUND WHITE BUILDING, PHILADELPHIA, PA 19104-4206
(215) 662-3261
(215) 319-8944
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060091000-02
KEYSTONE
PA
01
—
07282
HEALTHPARTNERS
PA
05
—
1001258770
—
PA
01
—
1011495
KEYSTONE MERCY
PA
01
—
131021
BLUE SHIELD
PA
01
—
273532
MAMSI
PA
01
—
461967
AETNA
PA
01
—
CA4067
RAILROAD MEDICARE
PA
Enumeration date
08/08/2006
Last updated
06/09/2008
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