Organization
UNIV OF PENN-ORTHOPEDIC SURGERY
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 SILVERSTEIN, PHILADELPHIA, PA 19104-4206
(215) 662-3340
(215) 349-5928
Mailing address
3624 MARKET ST, SUITE 560 W, PHILADELPHIA, PA 19104-2614
(215) 662-3958
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
PA
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
207XX0801X
Orthopaedic Trauma Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
PA
208200000X
Plastic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002Y21661
HEALTHNET
PA
01
—
005634
AETNA
PA
01
—
0719081000
KEYSTONE
PA
01
—
078517
BLUE SHIELD
PA
05
—
1007621110
—
PA
01
—
1012752
MERCY
PA
01
—
118204900
ACS
PA
01
—
13313
HEALTHPARTNERS
PA
01
—
203637
EEIOC
PA
01
—
273500
MAMSI
PA
01
—
3485021
NJ-MEDICAID
NJ
01
—
CA2832
RR MEDICARE
PA
01
—
G00030530
AMERICHOICE
PA
Enumeration date
08/16/2006
Last updated
06/10/2011
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