Active NPI
University of Penn - Dermatology
- Dermatology Physician
- Philadelphia, PA
National Provider Identifier
1174636153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- UNIVERSITY OF PENN - DERMATOLOGY
- Practice address
- 3400 Spruce St
2 Rhoads
Philadelphia, PA 19104-4206 - Phone
- (215) 662-2737
- Fax
- (215) 349-8339
- NPI assigned
- Aug 16, 2006
- Last updated
- Jan 23, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Elizabeth Johnston
- Title
- Executive Director
- Phone
- (215) 662-7583
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | NU | Primary | |
| Hematology & Oncology Physician | 207RH0003X | NU | ||
| Plastic Surgery Physician | 208200000X | NU | ||
| Surgery Physician | 208600000X | PA |
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 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003289 | Other | PA | MERCY |
| 1007486690 | Medicaid | PA | |
| 10385 | Other | PA | HEALTHPARTNERS |
| 273488 | Other | PA | MAMSI |
| 0156456000 | Other | PA | KEYSTONE |
| 196218 | Other | PA | BLUE SHIELD |
| CA5541 | Other | PA | RR MEDICARE |
| G00108540 | Other | PA | AMERICHOICE |
| 005987 | Other | PA | AETNA |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1201046400000",
"number": "1174636153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3624 MARKET ST",
"address_2": "SUITE 560W",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191042614",
"telephone_number": "215-662-2286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 SPRUCE ST",
"address_2": "2 RHOADS",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044206",
"telephone_number": "215-662-2737",
"fax_number": "215-349-8339"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "UNIVERSITY OF PENN - DERMATOLOGY",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-16",
"last_updated": "2008-01-23",
"status": "A",
"authorized_official_last_name": "JOHNSTON",
"authorized_official_first_name": "ELIZABETH",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "215-662-7583"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "207RH0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "PA",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCY",
"identifier": "1003289",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007486690",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "10385",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "273488",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE",
"identifier": "0156456000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "196218",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "CA5541",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICHOICE",
"identifier": "G00108540",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "005987",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
- University City Operator LLC (University City Rehabilitation and Healthcare Center)
- University Medevac, LLC
- University Neurosurgical, PC
- University of Penn - Anesthesia
- University of Penn - Dermatology
- University of Penn - Medical Group
- University of Penn - Medical Group
- University of Penn - Medical Group
- University of Penn - Medical Group
- University of Penn - Medical Group
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.