Organization
UNIVERSITY OF PENN - VASCULAR LAB
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, 4 SILVERSTEIN BUILDING, PHILADELPHIA, PA 19104-4206
(215) 662-2050
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0515700000
KEYSTONE
PA
01
—
2Y21676
HEALTHNET
PA
01
—
50099
AETNA
PA
01
—
681624
BLUE SHIELD
PA
01
—
CD2551
RR MEDICARE
PA
Enumeration date
08/19/2006
Last updated
06/09/2008
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