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General NPI Number Information
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NPI Number | 1205945367
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Entity Type | Organization
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Legal Business Name | UNIV OF PENN IMAGING CENTER
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3400 SPRUCE ST
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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 | 215-614-1926
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Fax |
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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 | 215-615-7583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology 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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology 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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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