Provider Demographics
NPI:1366869166
Name:UNIVERSITY OF PENNSYLVANIA HEALTH SYSTEM
Entity Type:Organization
Organization Name:UNIVERSITY OF PENNSYLVANIA HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:OTIENO
Authorized Official - Last Name:OUMA
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MSC
Authorized Official - Phone:301-233-0014
Mailing Address - Street 1:1629 W MATISSE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-9836
Mailing Address - Country:US
Mailing Address - Phone:301-233-0014
Mailing Address - Fax:
Practice Address - Street 1:51 N 39TH ST
Practice Address - Street 2:PHILADELPHIA, PA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:219-662-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014834275N00000X, 281P00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No281P00000XHospitalsChronic Disease Hospital