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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 (ENROLLMENT LEAD)
(215) 662-6187
Entity
Organization
Contact information
Practice address
3400 CIVIC CENTER BLVD, 3RD FLOOR, PHILADELPHIA, PA 19104-5127
(215) 662-3318
Mailing address
3400 CIVIC CENTER BLVD, 3RD FLOOR, PHILADELPHIA, PA 19104-5127
(215) 662-3318
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
—
PA
Other
Enumeration date
12/26/2014
Last updated
08/02/2023
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