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
3400 SPRUCE ST, 8 RAVDIN, PHILADELPHIA, PA 19104-4206
(215) 662-3228
(215) 349-8831
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
—
—
208000000X
Pediatrics Physician
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
—
2080P0202X
Pediatric Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0794792000
KEYSTONE
PA
05
—
1001258770
—
PA
01
—
1013506
KEYSTONE MERCY
PA
01
—
12502
HEALTHPARTNERS
PA
01
—
2Y22674
HEATLHNET
PA
01
—
502554
AETNA
PA
01
—
706905
BLUE SHIELD
PA
05
—
7160402
—
NJ
01
—
CI1503
RAILROAD MEDICARE
PA
Enumeration date
09/08/2006
Last updated
06/09/2008
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