Organization
UNIV OF PENN - OB-GYN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH JOHNSTON (EXECUTIVE DIRECTOR)
(215) 662-7583
Entity
Organization
Contact information
Practice address
801 SPRUCE ST, 8TH FLOOR, PHILADELPHIA, PA 19107-5701
(215) 829-6385
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0052759000
KEYSTONE
PA
01
—
065511
BLUE SHIELD
PA
05
—
1007448840
—
PA
01
—
1012028
KEYSTONE MERCY
PA
01
—
273502
MAMSI
PA
01
—
2735949
AETNA
PA
01
—
CG4675
RAILROAD MEDICARE
PA
Enumeration date
04/03/2007
Last updated
08/22/2020
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