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General NPI Number Information
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NPI Number | 1093725145
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF PENN - MEDICAL GROUP
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 3400 CIVIC CENTER BLVD EAST PAVILION, 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19104-5127
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Country | US
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Telephone | 215-615-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 CIVIC CENTER BLVD EAST PAVILION, 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19104-5127
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Country | US
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Telephone | 215-615-4949
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Fax |
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Authorized Official
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Title or Position | PAYER ENROLLMENT MANAGER
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Name | STACY GRECO
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Credential |
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Telephone | 223-341-8516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology 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 | 207RI0011X
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Taxonomy Name | Interventional Cardiology 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 | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | PA
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