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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