MEDICARE: TRUSTEES OF THE UNIV OF PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207ZB0001X	Blood Banking & Transfusion Medicine Physician	PA
2	207ZC0500X	Cytopathology Physician	PA
3	207ZD0900X	Dermatopathology (Pathology) Physician	PA
4	207ZF0201X	Forensic Pathology Physician	PA
5	207ZI0100X	Immunopathology Physician	PA
6	207ZM0300X	Medical Microbiology Physician	PA
7	207ZP0007X	Molecular Genetic Pathology (Pathology) Physician	PA
8	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	PA
9	207ZP0104X	Chemical Pathology Physician	PA
10	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	PA
11	207ZP0101X	Anatomic Pathology Physician	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	CN3127	OTHER	PA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	184052	OTHER	PA	BLUE SHIELD
2	300654	OTHER	PA	EEIOC
3	0170486000	OTHER	PA	KEYSTONE
4	25325	OTHER	PA	HEALTHPARTNERS
5	E98600	OTHER	PA	AMERICHOICE
6	273379	OTHER	PA	MAMSI
7	710842	OTHER	PA	AETNA
9	1038539	OTHER	PA	MERCY
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033225453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUSTEES OF THE UNIV OF PA

Provider Business Mailing Address
First Line	:	3624 MARKET ST
Second Line	:	SUITE 560W
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2614
Country	:	US
Telephone Number	:	215-662-2286
Fax Number	:	215-615-0500

Provider Business Practice Location Address
First Line	:	250 KING OF PRUSSIA RD
Second Line	:
City	:	RADNOR
State	:	PA
Zip	:	19087-5220
Country	:	US
Telephone Number	:	610-902-2000
Fax Number	:	610-902-2040

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ELIZABETH JOHNSTON
Credential	:
Telephone Number	:	215-662-7583

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	09/11/2025

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1902846942 — CAROL R FLEISCHMAN MD
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Directions to “TRUSTEES OF THE UNIV OF PA ” Practice Location

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