Healthcare Provider Details

I. General information

NPI: 1487865036
Provider Name (Legal Business Name): HOSPITAL OF UNIVERSITY OF PENNSYLVANIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST
PHILA PA
19104-4206
US

IV. Provider business mailing address

3101 MARKET ST SUITE 160
PHILADELPHIA PA
19104-2807
US

V. Phone/Fax

Practice location:
  • Phone: 215-349-5150
  • Fax: 215-615-0432
Mailing address:
  • Phone: 215-349-5150
  • Fax: 215-615-0432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS MCCORMICK
Title or Position: ASST VICE PRESIDENT FINANCE
Credential:
Phone: 215-662-2709