Organization
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
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) 902-5600
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0211219000
KEYSTONE
PA
05
—
1001258770
—
PA
01
—
1038515
MERCY
PA
01
—
17588
HEALTHPARTNERS
PA
01
—
2Y21509
HEALTHNET
PA
01
—
536910
BLUE SHIELD
PA
01
—
707804
AETNA
PA
01
—
CN3127
RR MEDICARE
PA
Enumeration date
08/18/2006
Last updated
01/06/2014
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