Organization
PENN MEDICINE CCP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH JOHNSTON (EXECUTIVE DIRECTOR)
(215) 662-7583
Entity
Organization
Contact information
Practice address
227 N BROAD ST, SUITE 200, PHILADELPHIA, PA 19107-1503
(215) 564-3050
Mailing address
227 N BROAD ST, SUITE 200, PHILADELPHIA, PA 19107-1503
(215) 564-3050
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
PA
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
PA
207RI0011X
Interventional Cardiology Physician
—
PA
Other
Enumeration date
08/09/2012
Last updated
02/12/2015
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