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General NPI Number Information
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NPI Number | 1659492122
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Entity Type | Organization
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Legal Business Name | UNIV OF PENN - OB-GYN
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 801 SPRUCE ST 8TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5701
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Country | US
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Telephone | 215-829-6385
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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 | 215-662-7583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number |
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License Number State | PA
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