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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
3400 SPRUCE ST, 1000 COURTYARD BUILDING, PHILADELPHIA, PA 19104-4206
(215) 662-3318
Mailing address
3400 SPRUCE ST, 1000 COURTYARD BUILDING, PHILADELPHIA, PA 19104-4206
(215) 662-3318

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
207VE0102X
Reproductive Endocrinology Physician
207VX0201X
Gynecologic Oncology Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0052759000
KEYSTONE
PA
01
039030
BLUE SHIELD
PA
05
1007448840
PA
01
1012026
KEYSTONE MERCY
PA
01
24223
HEALTHPARTNERS
PA
01
2Y20350
HEALTHNET
PA
01
544297
AETNA
PA
05
7298609
NJ
01
CA2050
RAILROAD MEDICARE
PA
Enumeration date
08/29/2006
Last updated
12/20/2011
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