Provider Demographics
NPI: | 1033225453 |
---|---|
Name: | TRUSTEES OF THE UNIV OF PA |
Entity Type: | Organization |
Organization Name: | TRUSTEES OF THE UNIV OF PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ELIZABETH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JOHNSTON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 215-662-7583 |
Mailing Address - Street 1: | 3624 MARKET ST |
Mailing Address - Street 2: | SUITE 560W |
Mailing Address - City: | PHILADELPHIA |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19104-2614 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 215-662-2286 |
Mailing Address - Fax: | 215-615-0500 |
Practice Address - Street 1: | 250 KING OF PRUSSIA RD |
Practice Address - Street 2: | |
Practice Address - City: | RADNOR |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19087-5220 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-902-2000 |
Practice Address - Fax: | 610-902-2040 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-21 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | 207ZB0001X, 207ZC0500X, 207ZD0900X, 207ZF0201X, 207ZI0100X, 207ZM0300X, 207ZP0007X, 207ZP0101X, 207ZP0102X, 207ZP0104X, 207ZP0105X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Not Answered | 207ZB0001X | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | Group - Multi-Specialty |
Not Answered | 207ZC0500X | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | Group - Multi-Specialty |
Not Answered | 207ZD0900X | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | Group - Multi-Specialty |
Not Answered | 207ZF0201X | Allopathic & Osteopathic Physicians | Pathology | Forensic Pathology | Group - Multi-Specialty |
Not Answered | 207ZI0100X | Allopathic & Osteopathic Physicians | Pathology | Immunopathology | Group - Multi-Specialty |
Not Answered | 207ZM0300X | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | Group - Multi-Specialty |
Not Answered | 207ZP0007X | Allopathic & Osteopathic Physicians | Pathology | Molecular Genetic Pathology | Group - Multi-Specialty |
Not Answered | 207ZP0101X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | Group - Multi-Specialty |
Not Answered | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
Not Answered | 207ZP0104X | Allopathic & Osteopathic Physicians | Pathology | Chemical Pathology | Group - Multi-Specialty |
Not Answered | 207ZP0105X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 184052 | Other | BLUE SHIELD |
PA | 300654 | Other | EEIOC |
PA | 0170486000 | Other | KEYSTONE |
PA | 25325 | Other | HEALTHPARTNERS |
PA | E98600 | Other | AMERICHOICE |
PA | 273379 | Other | MAMSI |
PA | 710842 | Other | AETNA |
PA | CN3127 | Other | RR MEDICARE |
PA | 1038539 | Other | MERCY |
NJ | 7537000 | Other | NJ-MEDICAID |
PA | 1001258770 | Medicaid |