Organization
UNIV OF PENN RADIATION ONCOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH JOHNSTON (EXECUTIVE DIRECTOR)
(215) 662-7293
Entity
Organization
Contact information
Practice address
51 N 39TH ST, PHILADELPHIA, PA 19104-2640
(215) 662-7293
Mailing address
3624 MARKET ST, STE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015578830007
—
PA
01
—
828248
BLUE SHIELD
PA
Enumeration date
05/26/2006
Last updated
01/06/2014
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