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
(610) 902-2040
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
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
PA
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002Y21509
HEALTHNET
PA
01
—
0143087000
KEYSTONE
PA
01
—
096188
BLUE SHIELD
PA
05
—
1001258770
—
PA
01
—
1038558
MERCY
PA
01
—
116472401
ACS
PA
01
—
25562
HEALTHPARTNERS
PA
01
—
273357
MAMSI
PA
01
—
300654
EEIOC
PA
01
—
707829
AETNA
PA
01
—
A73600
AMERICHOICE
PA
01
—
CN3127
RR MEDICARE
PA
Enumeration date
08/18/2006
Last updated
05/08/2008
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