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Organization
UNIVERSITY OF PENN - MEDICAL GROUP
Active
Organization
UNIVERSITY OF PENN - MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTE L JACKSON (PROJECT LEAD)
(267) 207-7303
Entity
Organization
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(888) 722-3497
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(888) 722-3497
Taxonomy
Speciality
Code
Description
License number
State
207RA0002X
Adult Congenital Heart Disease Physician
—
NULL
207RA0002X
Adult Congenital Heart Disease Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
NULL
207RC0000X
Cardiovascular Disease Physician
—
—
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
—
NULL
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
12/04/2024
Last updated
12/04/2024
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