University of Penn - Dermatology

Organization Active NPI Clinical Medical Laboratory · Philadelphia, PA

NPI 1003946153 · NPPES record last updated Apr 12, 2013

Key facts

NPI
1003946153
Entity type
Organization (NPI type 2)
Primary specialty
Clinical Medical Laboratory 291U00000X
Legal business name
UNIVERSITY OF PENN - DERMATOLOGY
Practice address
3400 Spruce St
2 Rhoads
Philadelphia, PA 19104-4206
Phone
(215) 662-2737
NPI assigned
Mar 7, 2007
Organization subpart
No

Authorized official

Name
Elizabeth Johnston
Title
Enrollment Coordinator
Phone
(215) 662-7583

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Locations

801 Spruce St
#10
Philadelphia, PA 19107
Phone (267) 519-0154

3600 Spruce St
#2
Philadelphia, PA 19104
Phone (215) 662-2200

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Yes

Addresses

Primary practice location

3400 Spruce St
2 Rhoads
Philadelphia, PA 19104-4206

Mailing address

3624 Market St
Suite 560W
Philadelphia, PA 19104-2614
Phone (215) 662-2286

Other identifiers

IdentifierTypeStateIssuer
14945OtherPAHEALTHPARTNERS
2214380000OtherPAKEYSTONE
80939OtherPABLUE SHIELD
CA5541OtherPARAILROAD MEDICARE
1007486690MedicaidPA
1024157OtherPAKEYSTONE MERCY
1117604OtherPAAETNA

Other providers in Philadelphia, PA

All providers in Philadelphia, PA · Clinical Medical Laboratory in Pennsylvania

Sources for this page

Verify at the official NPI Registry.