Organization
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Active
Other names
Univ of Penn - Pathology & Lab
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, PHILADELPHIA, PA 19104-4206
(215) 662-6503
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-3958
(866) 586-2431
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
—
207ZN0500X
Neuropathology Physician
—
—
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
207ZP0104X
Chemical Pathology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0410025000
KEYSTONE
PA
01
—
1034927
KEYSTONE MERCY
PA
01
—
35081
HEALTHPARTNERS
PA
01
—
3591047
AETNA
PA
01
—
588106
BLUE SHIELD
PA
01
—
DB3215
RAILROAD MEDICARE
PA
Enumeration date
08/29/2006
Last updated
01/24/2011
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