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
800 WALNUT ST, 10TH FLOOR, PHILADELPHIA, PA 19107-5109
(215) 829-2345
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
PA
207VX0201X
Gynecologic Oncology Physician
—
PA
261QA0005X
Ambulatory Family Planning Facility
—
PA
261QA0006X
Ambulatory Fertility Facility
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0052759000
KEYSTONE
PA
01
—
065511
BLUE SHIELD
PA
05
—
1007448840
—
PA
01
—
1012026
KEYSTONE MERCY
PA
01
—
2Y21658
HEALTHNET
PA
05
—
7298609
—
NJ
01
—
921502
AETNA
PA
01
—
CG4675
RAILROAD MEDICARE
PA
Enumeration date
04/03/2007
Last updated
10/24/2013
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