UNIV OF PENN - RADIOLOGY (NPI# 1013920503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013920503 |
| Entity Type | Organization |
| Organization Name | UNIV OF PENN - RADIOLOGY |
| Practice Address |
3400 Spruce St Ground Floor Dulles Philadelphia PA 19104-4206 |
| Mailing Address |
3624 Market St Suite 560w Philadelphia PA 19104-2614 |
| Practice Telephone | 2156623005 |
| Practice Fax Number | 2156627011 |
| Mailing Telephone | 2156622286 |
| Mailing Fax Number | 2156150500 |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | ELIZABETH JOHNSTON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2156623005 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 2085N0700X |
Radiology Specialization: Neuroradiology |
Allopathic & Osteopathic Physicians | ||
| X | 2085N0904X |
Radiology Specialization: Nuclear Radiology |
Allopathic & Osteopathic Physicians | ||
| X | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians | ||
| X | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | BLUE SHIELD | 160728 | 01 |
| PA | 1001258770 | 05 | |
| PA | HEALTHNET | 3Y30270 | 01 |
| PA | AETNA | 002144 | 01 |
| PA | KEYSTONE | 0834536000 | 01 |
| PA | HEALTHPARTNERS | 10371 | 01 |
| PA | KEYSTONE MERCY | 45459 | 01 |
| NJ | 8837007 | 05 | |
| PA | RAILROAD MEDICARE | DA4009 | 01 |
| Street Address |
3400 SPRUCE ST GROUND FLOOR DULLES |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19104-4206 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063415966 | Samuel Isaiah Parry | Obstetrics & Gynecology | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2005-05-24 |
| 1831790609 | Renate Marie Balitzky | Registered Nurse | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-11-06 |
| 1053911156 | Jordan Charles Templeton | Physician Assistant | 3400 Spruce St, Philadelphia, PA 19104-4274 | 2020-10-28 |
| 1992305304 | Alyssa N Volpe | Registered Nurse | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-10-27 |
| 1700486115 | Christina Haddow | Registered Nurse | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-10-27 |
| 1629677497 | Marissa Leigh Berlant | Physician Assistant | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-10-22 |
| 1811595523 | Kristen Gilgen | Anesthesiology | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-10-14 |
| 1962014654 | Stacey Pham | Nurse Practitioner | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-08-23 |
| 1265040109 | Abdullah T Almuqate | Pathology | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-07-16 |
| 1952928541 | Stefen Andrianus | Student in an Organized Health Care Education/Training Program | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-06-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639770829 | Michelle Morris | Student in an Organized Health Care Education/Training Program | Dept. of Family Medicine & Community Health, 3737 Market, Philadelphia, PA 19104 | 2020-11-04 |
| 1346853041 | Spectrum Health Services, Inc. | Clinic/Center | 1415 South University Ave, Philadelphia, PA 19104 | 2020-08-24 |
| 1770104259 | Fatimah Sorefan-mangou | Student in an Organized Health Care Education/Training Program | 4 Maloney 3400 Spruce Street, Philadelphia, PA 19104 | 2020-05-06 |
| 1114548690 | Rebecca Blaguski | Registered Nurse | The Hospital of The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 | 2020-05-06 |
| 1952944175 | Rebecca Miriam Barmherzig | Psychiatry & Neurology | 3501 Civic Centre Blvd, 10th Flr Ctrb, Neurology, Philadelphia, PA 19104 | 2019-10-21 |
| 1891257101 | James Paul Byrne | Surgery | Penn Presbyterian Medical Center, Division of Trauma, S, 51 N. 39th Street, Suite 120, 1st Floor Medical Office, Philadelphia, PA 19104 | 2019-04-04 |
| 1093276453 | Lauren Shreve | Student in an Organized Health Care Education/Training Program | Department of Surgery, Surgery Education - Penn Health, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104 | 2019-03-28 |
| 1285194282 | Lauren M Christie | Student in an Organized Health Care Education/Training Program | Penn Presbyterian Medical Center, 51 N. 39th Street, Philadelphia, PA 19104 | 2019-03-25 |
| 1114487683 | Sabrina Layne | Student in an Organized Health Care Education/Training Program | 3400 Spruce Street, 100 Centrex, Philadelphia, PA 19104 | 2019-03-21 |
| 1811457310 | Kia Lor | Student in an Organized Health Care Education/Training Program | Hospital of University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104 | 2019-03-21 |
| Find all providers in zip 19104 | ||||
| Taxonomy Code | 2085N0700X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Neuroradiology |
| A radiologist who diagnoses and treats diseases utilizing imaging procedures as they relate to the brain, spine and spinal cord, head, neck and organs of special sense in adults and children. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164664421 | Vitaly Izgur | Radiology | 2201 Strahle St, Apt A-12, Philadelphia, PA 19152-2530 | 2009-04-01 |
| 1164536827 | National Imaging P.C. | Radiology | 1903 S Broad St # 05, Philadelphia, PA 19148-2216 | 2006-08-19 |
| 1518903780 | Frederic Joshua Barnett | Radiology | 39th & Market Streets, Philadelphia, PA 19104 | 2006-06-22 |
| 1588620686 | Kedar Kulkarni | Radiology | 901 N Penn St, #302, Philadelphia, PA 19123-3132 | 2006-04-26 |
| 1194342980 | Sara Reis Teixeira | Radiology | 3401 Civic Center Blvd, Division of Pediatric Neuroradiology, Philadelphia, PA 19104-4319 | 2020-06-29 |
| 1073157376 | Anilawan Smitthimedhin | Radiology | 3401 Civic Center Blvd, Philadelphia, PA 19104-4319 | 2019-10-30 |
| 1780165449 | Prabath Kumar Mondel | Radiology | 132 S 10th St Fl 10, Philadelphia, PA 19107-5244 | 2018-08-21 |
| 1114443082 | Seyed Ali Mosallaie | Radiology | 132 S 10th St, Philadelphia, PA 19107-5244 | 2017-08-22 |
| 1881114700 | Haykanush Zakaryan | Radiology | 132 S 10th St, Philadelphia, PA 19107-5244 | 2017-06-21 |
| 1164962148 | Lodespoto Medical of Pa Pllc | Radiology | 1500 Market Street, 12th Floor East Tower, Philadelphia, PA 19102-2152 | 2017-02-24 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.