Organization
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH JOHNSTON (EXECUTIVE DIRECTOR)
(215) 662-7583
Entity
Organization
Contact information
Practice address
250 KING OF PRUSSIA RD, RADNOR, PA 19087-5220
(610) 902-5600
(610) 902-5604
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002Y21509
HEALTHNET
PA
01
—
0430126000
KEYSTONE
PA
05
—
1001258770
—
PA
01
—
1043406
MERCY
PA
01
—
116472401
ACS
PA
01
—
18326
HEALTHPARTNERS
PA
01
—
273375
MAMSI
PA
01
—
300654
EEIOC
PA
01
—
710754
AETNA
PA
01
—
965753
BLUE SHIELD
PA
01
—
CN3217
RR MEDICARE
PA
01
—
G00024130
AMERICHOICE
PA
Enumeration date
08/21/2006
Last updated
01/06/2014
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