# UNIVERSITY OF PENN-MEDICAL GROUP

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

## Provider details

- **NPI number:** 1306234414
- **Authorized official:** CHANTE L JACKSON (ENROLLMENT LEAD)
- **Authorized official phone:** (215) 662-6187

## Contact information

- **Practice address:** 51 N 39TH ST, PHILADELPHIA, PA 19104-2640
- **Practice address phone:** (215) 349-8310
- **Mailing address:** 51 N 39TH ST, PHILADELPHIA, PA 19104-2640
- **Mailing address phone:** (215) 349-8310

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | PA | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | PA | Yes |
| 2084P2900X | Pain Medicine (Psychiatry & Neurology) Physician | — | PA | — |

## Other

- **Enumeration date:** 12/26/2014
- **Last updated:** 11/19/2020