| University Of Penn - Medical Group | |
|
3400 Spruce St One Maloney Philadelphia PA 19104-4206 | |
| (215) 662-4740 | |
| Not Available |
| Full Name | University Of Penn - Medical Group |
|---|---|
| Speciality | Medical Genetics |
| Location | 3400 Spruce St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Chante L Jackson (ENROLLMENT LEAD) |
| Authorized Official Contact | 2156626187 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| University Of Penn - Medical Group 3400 Spruce St One Maloney Philadelphia PA 19104-4206 Ph: (215) 662-4740 | University Of Penn - Medical Group 3400 Spruce St One Maloney Philadelphia PA 19104-4206 Ph: (215) 662-4740 |
| NPI Number | 1912014614 |
|---|---|
| Provider Enumeration Date | 08/25/2006 |
| Last Update Date | 11/20/2020 |
| Medicare PECOS PAC ID | 6204730955 |
|---|---|
| Medicare Enrollment ID | O20141209000072 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912014614 | NPI | - | NPPES |
| 0053945000 | Other | PA | KEYSTONE |
| 1061396 | Other | PA | MERCY |
| CA0235 | Other | PA | RR MEDICARE |
| 0002Y20116 | Other | PA | HEALTHNET |
| 147249 | Other | PA | BLUE SHIELD |
| 980167 | Other | PA | AETNA |
| 26256 | Other | PA | HEALTHPARTNERS |
| 273231 | Other | PA | MAMSI |
| 0006610360 | Medicaid | PA | |
| 7768508 | Other | NJ | NJ-MEDICAID |
| G00053120 | Other | PA | AMERICHOICE |
| Provider Name | Amy C Goldstein |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1437122066 PECOS PAC ID: 0345217394 Enrollment ID: I20040910000622 |
| Provider Name | Katherine Leah Nathanson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1841226024 PECOS PAC ID: 0941216881 Enrollment ID: I20060301000432 |
| Provider Name | Daniel E Soffer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205863198 PECOS PAC ID: 1355437963 Enrollment ID: I20071012000155 |
| Provider Name | Dwight E Stambolian |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1093807489 PECOS PAC ID: 1557496510 Enrollment ID: I20100316000301 |
| Provider Name | Reed Edwin Pyeritz |
|---|---|
| Provider Type | Practitioner - Medical Genetics And Genomics |
| Provider Identifiers | NPI Number: 1669401170 PECOS PAC ID: 2567597362 Enrollment ID: I20100318000537 |
| Provider Name | Staci M Kallish |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1811152796 PECOS PAC ID: 0244367522 Enrollment ID: I20100419000058 |
| Provider Name | Archna Bajaj |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1093078529 PECOS PAC ID: 2961718408 Enrollment ID: I20151218000201 |
| Provider Name | Maria Lynne Bonanni |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821336140 PECOS PAC ID: 7416238209 Enrollment ID: I20170110002804 |
| Provider Name | Rebecca Z Burdett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275043309 PECOS PAC ID: 6608125067 Enrollment ID: I20180817000418 |
| Provider Name | Theodore George Drivas |
|---|---|
| Provider Type | Practitioner - Medical Genetics And Genomics |
| Provider Identifiers | NPI Number: 1750776225 PECOS PAC ID: 6305170580 Enrollment ID: I20190621000336 |
| Provider Name | Kim Choong Wen Ng |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1336650456 PECOS PAC ID: 9436552189 Enrollment ID: I20210720000079 |
| Provider Name | Jessica Gold |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922412295 PECOS PAC ID: 9830499870 Enrollment ID: I20220221002058 |
| Provider Name | Sohil Golwala |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245727643 PECOS PAC ID: 0749535185 Enrollment ID: I20220709000864 |
| Provider Name | Mersedeh Rohanizadegan |
|---|---|
| Provider Type | Practitioner - Medical Genetics And Genomics |
| Provider Identifiers | NPI Number: 1639433220 PECOS PAC ID: 6901154038 Enrollment ID: I20230404001116 |
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University Of Penn - Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3400 Spruce St, 3 Ravdin, Suite F, Pulmonary & Critical Care, Philadelphia, PA 19104 Phone: 215-662-3202 | |