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General NPI Number Information
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NPI Number | 1770796385
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Entity Type | Organization
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Legal Business Name | U. OF PA STUDENT HEALTH SERVICE
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 399 S 34TH ST LOWER LEVEL, PENN TOWER
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4316
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Country | US
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Telephone | 215-662-2868
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Fax |
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Provider Business Mailing Address
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Address Line | 399 S 34TH ST LOWER LEVEL, PENN TOWER
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4316
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Country | US
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Telephone | 215-662-2868
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. EVELYN WIENER
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Credential | MD
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Telephone | 215-662-2868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number | MD021924E
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License Number State | PA
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