Healthcare Provider Details

I. General information

NPI: 1043670805
Provider Name (Legal Business Name): UNIVERSITY OF PENN-MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 N DUKE ST 3RD FLOOR GI TRANSPLANT
LANCASTER PA
17602-2225
US

IV. Provider business mailing address

554 N DUKE ST 3RD FLOOR GI TRANSPLANT
LANCASTER PA
17602-2225
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-6200
  • Fax: 215-662-2244
Mailing address:
  • Phone: 215-662-6200
  • Fax: 215-662-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STACY GRECO
Title or Position: PAYER ENROLLMENT MANAGER
Credential:
Phone: 223-341-8516