Organization
UNIV OF PENN-NEUROSURGERY
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, 3 SILVERSTEIN, PHILADELPHIA, PA 19104-4206
(215) 662-3487
(215) 349-5534
Mailing address
3624 MARKET ST, SUITE 560 W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
(866) 586-2431
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002Y20049
HEALTHNET
PA
05
—
0007557130
—
PA
01
—
0052213000
KEYSTONE
PA
01
—
055952
BLUE SHIELD
PA
01
—
06713
HEALTHPARTNERS
PA
01
—
093237
AETNA
PA
01
—
118188100
ACS
PA
01
—
273496
MAMSI
PA
01
—
4193113
NJ-MEDICAID
NJ
01
—
47781
MERCY
PA
01
—
CG4674
RR MEDICARE
PA
01
—
G00031380
AMERICHOICE
PA
Enumeration date
08/16/2006
Last updated
10/25/2013
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