Organization
UNIVERSITY OF PENN - DERMATOLOGY
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, 2 RHOADS, PHILADELPHIA, PA 19104-4206
(215) 662-2737
(215) 349-8339
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207RH0003X
Hematology & Oncology Physician
—
—
208200000X
Plastic Surgery Physician
—
—
208600000X
Surgery Physician
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005987
AETNA
PA
01
—
0156456000
KEYSTONE
PA
01
—
1003289
MERCY
PA
05
—
1007486690
—
PA
01
—
10385
HEALTHPARTNERS
PA
01
—
196218
BLUE SHIELD
PA
01
—
273488
MAMSI
PA
01
—
CA5541
RR MEDICARE
PA
01
—
G00108540
AMERICHOICE
PA
Enumeration date
08/16/2006
Last updated
01/23/2008
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