Basic Information
Provider Information
NPI: 1902920739
EntityType: 2
ReplacementNPI:  
OrganizationName: TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
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Mailing Information
Address1: 3624 MARKET ST
Address2: SUITE 560W
City: PHILADELPHIA
State: PA
PostalCode: 191042614
CountryCode: US
TelephoneNumber: 2156622286
FaxNumber:  
Practice Location
Address1: 3400 SPRUCE ST
Address2: 4TH FLOOR SILVERSTEIN
City: PHILADELPHIA
State: PA
PostalCode: 191044206
CountryCode: US
TelephoneNumber: 2156154949
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/19/2007
LastUpdateDate: 01/06/2014
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AuthorizedOfficialLastName: JOHNSTON
AuthorizedOfficialFirstName: ELIZABETH
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AuthorizedOfficialTitleorPosition: EXECUTIVE DIRECTOR
AuthorizedOfficialTelephone: 2156627583
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IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2086S0129X PAN193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
363LA2200X PAN193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
208600000X PAY193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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