Organization
UNIVERSITY OF PENN-ANESTHESIA
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, 4 DULLES, PHILADELPHIA, PA 19104-4206
(215) 349-8310
Mailing address
3400 SPRUCE ST, 4 DULLES, PHILADELPHIA, PA 19104-4238
(215) 349-8310
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
PA
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
—
PA
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006733040
—
PA
01
—
0056969000
KEYSTONE
PA
01
—
401256
BLUE SHEILD
PA
01
—
542967
AETNA
PA
Enumeration date
03/06/2007
Last updated
07/24/2014
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