Organization
UNIVERSITY OF PENN-RAD ONC
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, 2 DONNER BUILDING, PHILADELPHIA, PA 19104-4206
(215) 662-2428
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015038730010
—
PA
01
—
1601754
BLUE SHIELD
PA
Enumeration date
05/27/2006
Last updated
06/28/2011
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