Organization
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Active
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) 902-2000
(610) 902-2040
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002Y21509
HEALTHNET
PA
01
—
0362759000
KEYSTONE
PA
05
—
1001258770
—
PA
01
—
1038531
MERCY
PA
01
—
116472401
ACS
PA
01
—
20751
HEALTHPARTNERS
PA
01
—
263060
BLUE SHIELD
PA
01
—
273400
MAMSI
PA
01
—
300654
EEIOC
PA
01
—
710906
AETNA
PA
01
—
CN3127
RR MEDICARE
PA
Enumeration date
09/07/2006
Last updated
05/22/2008
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