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
51 N 39TH ST, 7 FLOOR-MUTCH BUILDING, PHILADELPHIA, PA 19104-2640
(215) 662-8777
(215) 243-3290
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
PA
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0361490000
KEYSTONE
PA
01
—
30008890
MERCY
PA
01
—
33655
HEALTHPARTNERS
PA
Enumeration date
11/09/2006
Last updated
08/08/2014
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