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General NPI Number Information
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NPI Number | 1174636153
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF PENN - DERMATOLOGY
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 3400 SPRUCE ST 2 RHOADS
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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 | 215-662-2737
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Fax | 215-349-8339
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Provider Business Mailing Address
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Address Line | 3624 MARKET ST SUITE 560W
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2614
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Country | US
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Telephone | 215-662-2286
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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 | 208600000X
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Taxonomy Name | Surgery 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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology 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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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