Organization
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH JOHNSTON (EXECUTIVE DIRECTOR)
(215) 662-7583
Entity
Organization
Contact information
Practice address
250 KING OF PRUSSIA RD, RADNOR, PA 19087-5220
(610) 902-2000
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-3958
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
PA
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0099754000
KEYSTONE
PA
05
—
1001258770
—
PA
01
—
2Y21509
HEALTHNET
PA
01
—
30003460
MERCY
PA
01
—
3066533
AETNA
PA
01
—
32995
HEALTHPARTNERS
PA
01
—
888463
BLUE SHIELD
PA
01
—
CN3127
RR MEDICARE
PA
Enumeration date
08/18/2006
Last updated
11/10/2010
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