# UNIVERSITY OF PENN - MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184430258
- **Authorized official:** CHANTE L JACKSON (PROJECT LEAD)
- **Authorized official phone:** (267) 207-7303

## Contact information

- **Practice address:** 3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
- **Practice address phone:** (888) 722-3497
- **Mailing address:** 3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
- **Mailing address phone:** (888) 722-3497

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 207SG0201X | Clinical Genetics (M.D.) Physician | — | — | Yes |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 12/04/2024
- **Last updated:** 12/04/2024