Organization
JEFFERSON UNIVERSITY PHYSICIANS
Active
Other names
Medical Oncology
Organization subpart
No
Provider details
NPI number
Authorized official
HRISTOS RISTAS (VP OF PROVIDER NETWORK OPERATIONS)
(215) 955-9298
Entity
Organization
Contact information
Practice address
925 CHESTNUT ST STE 320A, PHILADELPHIA, PA 19107-4216
(215) 955-8874
Mailing address
1100 MARKET ST FL 30, PHILADELPHIA, PA 19107-3601
(215) 955-1175
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0358994000
INDEPENDENCE BLUE CROSS
PA
01
—
0466144
AETNA
PA
01
—
1004298
KEYSTONE MERCY
PA
01
—
1051598
KEYSTONE MERCY
PA
01
—
435778
HIGHMARK BLUE SHIELD
PA
05
—
7616708
—
NJ
Enumeration date
04/18/2008
Last updated
12/13/2020
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