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General NPI Number Information
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NPI Number | 1063541779
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF PENN-ANESTHESIA
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/24/2014
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Provider Practice Location Address
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Address Line | 3400 SPRUCE ST 4 DULLES
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4206
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Country | US
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Telephone | 215-349-8310
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 SPRUCE ST 4 DULLES
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4238
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Country | US
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Telephone | 215-349-8310
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ELIZABETH JOHNSTON
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Credential |
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Telephone | 215-662-7583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number |
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License Number State | PA
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