Organization
UNIVERSITY OF PENN-NEUROLOGY ASSTS.
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 RAVDIN, PHILADELPHIA, PA 19104-4206
(215) 662-3606
Mailing address
3400 SPRUCE ST, 2 RAVDIN, PHILADELPHIA, PA 19104-4206
(215) 662-3606
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
PA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002Y21675
HEALTHNET
PA
01
—
005023
AETNA
PA
01
—
0055785000
KEYSTONE
PA
01
—
039188
BLUE SHIELD
PA
05
—
1001258770
—
PA
01
—
1008658
MERCY
PA
01
—
10375
HEALTHPARTNERS
PA
01
—
118289600
ACS
PA
01
—
203677
EEIOC
PA
01
—
273304
MAMSI
PA
05
—
3578909
—
NJ
01
—
CA1585
RR MEDICARE
PA
01
—
G00031400
AMERICHOICE
PA
Enumeration date
08/30/2006
Last updated
01/06/2014
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