Organization
UNIV OF PENN- OB-GYN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH JOHNSTON (EXECUTIVE DIRECTOR)
(215) 662-7583
Entity
Organization
Contact information
Practice address
801 SPRUCE ST, 8TH FLOOR, PHILADELPHIA, PA 19107-5701
(215) 829-7201
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0052759000
KEYSTONE
PA
01
—
065511
BLUE SHIELD
PA
05
—
1007448840
—
PA
01
—
1012026
MERCY
PA
01
—
273503
MAMSI
PA
01
—
27541
HEALTHPARTNERS
PA
01
—
2Y21658
HEALTHNET
PA
01
—
921502
AETNA
PA
01
—
CG4675
RR MEDICARE
PA
01
—
G00071400
AMERICHOICE
PA
Enumeration date
08/30/2006
Last updated
06/25/2008
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