Organization
UNIV OF PENN-UROLOGY
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, 9 PENN TOWER, PHILADELPHIA, PA 19104-4206
(215) 662-2891
(215) 662-6764
Mailing address
3624 MARKET ST, SUITE 560 W, 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
—
0053471000
KEYSTONE
PA
01
—
006782
AETNA
PA
01
—
056674
BLUE SHIELD
PA
01
—
06723
HEALTHPARTNERS
PA
05
—
1007618490
—
PA
01
—
1011505
MERCY
PA
01
—
203679
EEIOC
PA
01
—
273263
MAMSI
PA
01
—
7557302
NJ-MEDICAID
NJ
01
—
CA1238
RR MEDICARE
PA
Enumeration date
08/15/2006
Last updated
08/22/2020
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