Organization
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Active
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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