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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
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4206
(215) 662-6503
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4206
(215) 662-6503

Taxonomy

Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
207ZN0500X
Neuropathology Physician
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
207ZP0104X
Chemical Pathology Physician
2084P0800X
Psychiatry Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0059902000
KEYSTONE
PA
01
052103
AETNA
PA
05
1001258770
PA
01
10377
HEALTHPARTNERS
PA
01
133759
BLUE SHIELD
PA
01
2Y23099
HEALTHNET
PA
05
7537000
NJ
01
CA9036
RAILROAD MEDICARE
PA
Enumeration date
09/07/2006
Last updated
12/18/2007
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