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Organization

TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ELIZABETH JOHNSTON (EXECUTIVE DIRECTOR)
21566627583
Entity
Organization

Contact information

Practice address
250 KING OF PRUSSIA RD, RADNOR, PA 19087-5220
(610) 902-2000
Mailing address
3624 MARKET ST, 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
207XS0117X
Orthopaedic Surgery of the Spine Physician
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
207XX0801X
Orthopaedic Trauma Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0982473000
KEYSTONE
PA
05
1001258770
PA
01
103084
BLUE SHIELD
PA
01
1038445
MERCY
PA
01
17601
HEALTHPARTNERS
PA
01
2Y21509
HEALTHNET
PA
01
706604
AETNA
PA
01
CN3127
RR MEDICARE
PA
Enumeration date
08/21/2006
Last updated
05/22/2008
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