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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