NPIMap

Organization Active NPI

Trustees of the University of Pennsylvania

  • Psychiatry Physician
  • Radnor, PA
National Provider Identifier
1417063835
Registry record updated May 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Practice address
250 King of Prussia Rd
Radnor, PA 19087-5220
Phone
(610) 902-2000
Fax
(610) 902-2040
NPI assigned
Aug 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2008

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

250 King of Prussia Rd
Radnor, PA 19087-5220

Mailing address

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

Other identifiers 5

IdentifierTypeStateIssuer
0002Y21509OtherPAHEALTHNET
267560OtherPABLUE SHIELD
1001258770019MedicaidPA
1196462OtherPAAETNA
CN3127OtherPARR MEDICARE

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211414400000",
    "number": "1417063835",
    "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": "250 KING OF PRUSSIA RD",
            "city": "RADNOR",
            "state": "PA",
            "postal_code": "190875220",
            "telephone_number": "610-902-2000",
            "fax_number": "610-902-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2008-05-22",
        "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": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "0002Y21509",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "267560",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1001258770019",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1196462",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CN3127",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Radnor, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 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.

Verify at the official NPI Registry.