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NPI Code Detail

MEDICARE: UPENN LIFE

MEDICARE: UPENN LIFE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1302R00000XHealth Maintenance OrganizationMD421701PA

General Provider Information

NPI Number : 1053576835
Entity Type Code : Organization
Provider Name (Legal Business Name) : UPENN LIFE
Provider Business Mailing Address
First Line : 4508 CHESTNUT ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19139-3608
Country : US
Telephone Number : 215-573-7200
Fax Number :
Provider Business Practice Location Address
First Line : 4508 CHESTNUT ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19139-3608
Country : US
Telephone Number : 215-573-7200
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. BRUCE KINOSIAN
Credential : MD
Telephone Number : 215-573-7200
Provider Enumeration Date : 07/22/2008
Last Update Date : 07/22/2008

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Directions to “UPENN LIFE ” Practice Location

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