Organization
UNIV OF PENN COMMUNITY RADIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH JOHNSTON (EXECUTIVE DIRECTOR)
(215) 662-7583
Entity
Organization
Contact information
Practice address
999 OLD EAGLE SCHOOL RD, WAYNE, PA 19087-1707
(215) 702-3100
(215) 702-3105
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-3958
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002Y22562
HEALTHNET
PA
05
—
0016394230
—
PA
01
—
0794791000
KEYSTONE
PA
01
—
31072
HEALTHPARTNERS
PA
01
—
33158
MERCY
PA
01
—
548327
CIGNA
PA
01
—
705030
BLUE SHIELD
PA
05
—
8390801
—
NJ
Enumeration date
08/14/2006
Last updated
07/15/2011
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