Organization
UNIV OF PENN IMAGING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH JOHNSTON (EXECUTIVE DIRECTOR)
(215) 615-7583
Entity
Organization
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4206
(215) 614-1926
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0707592000
KEYSTONE
PA
05
—
1007650890
—
PA
01
—
1035403
MERCY
PA
01
—
2Y223279
HEALTHNET
PA
01
—
31473
HEALTHPARTERNS
PA
01
—
471861
AETNA
PA
01
—
764089
BLUE SHIELD
PA
01
—
CH6040
RR MEDICARE
PA
Enumeration date
08/30/2006
Last updated
09/11/2025
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