Organization
UNIV OF PENN-OTORHINOLARYNGOLOGY
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, 5 SILVERSTEIN, PHILADELPHIA, PA 19104-4206
(215) 662-2777
(215) 662-4613
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
207Y00000X
Otolaryngology Physician
Primary
—
PA
207YS0123X
Facial Plastic Surgery Physician
—
—
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
—
—
207YX0602X
Otolaryngic Allergy Physician
—
—
207YX0901X
Otology & Neurotology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002Y21659
HEALTHNET
PA
05
—
0016786460
—
PA
01
—
0111428000
KEYSTONE
PA
01
—
099961
AETNA
PA
01
—
1002205
MERCY
PA
01
—
103681
HEALTHPARTNERS
PA
01
—
203652
EEIOC
PA
01
—
209916800
ACS
PA
01
—
273501
MAMSI
PA
01
—
520160
BLUE SHIELD
PA
01
—
7526105
NJ-MEDICAID
NJ
01
—
CN0179
RR MEDICARE
PA
01
—
G00031410
AMERICHOICE
PA
Enumeration date
08/16/2006
Last updated
06/25/2008
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