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 560W, PHILADELPHIA, PA 19104-2614
(215) 662-3958
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
PA
2086S0122X
Plastic and Reconstructive Surgery Physician
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002Y21509
HEALTHNET
PA
01
—
0270076000
KEYSTONE
PA
05
—
1001258770
—
PA
01
—
1038597
MERCY
PA
01
—
116472401
ACS
PA
01
—
18898
HEALTHPARTNERS
PA
01
—
273381
MAMSI
PA
01
—
300654
EEIOC
PA
01
—
700360
BLUE SHIELD
PA
01
—
710873
AETNA
PA
01
—
CN3127
RR MEDICARE
PA
01
—
G00021010
AMERICHOICE
PA
Enumeration date
08/21/2006
Last updated
03/07/2011
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