Organization
UNIVERSITY OF PENN - MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY GRECO (PAYER ENROLLMENT MANAGER)
(223) 341-8516
Entity
Organization
Contact information
Practice address
3400 CIVIC CENTER BLVD, EAST PAVILION, 2ND FLOOR, PHILADELPHIA, PA 19104-5127
(215) 615-4949
Mailing address
3400 CIVIC CENTER BLVD, EAST PAVILION, 2ND FLOOR, PHILADELPHIA, PA 19104-5127
(215) 615-4949
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
PA
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
PA
207RI0011X
Interventional Cardiology Physician
—
PA
207UN0901X
Nuclear Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002Y20116
HEATHNET
PA
05
—
0006610360
—
PA
01
—
027133400001
KEYSTONE
PA
01
—
058354
BLUE SHIELD
PA
01
—
1003417
KEYSTONE MERCY
PA
01
—
10670
HEALTHPARTNERS
PA
01
—
273543
MAMSI
PA
01
—
496667
AETNA
PA
01
—
5541301
NJ MEDICAID
NJ
01
—
CA0235
RR MEDICARE
PA
Enumeration date
08/09/2006
Last updated
07/31/2025
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