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General NPI Number Information
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NPI Number | 1760552434
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Entity Type | Organization
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Legal Business Name | TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 51 N 39TH ST 7 FLOOR-MUTCH BUILDING
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2640
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Country | US
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Telephone | 215-662-8777
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Fax | 215-243-3290
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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 | 215-615-0500
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) 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 | 207Q00000X
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Taxonomy Name | Family Medicine 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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | PA
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