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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 SPRUCE ST, 8 RAVDIN, PHILADELPHIA, PA 19104-4238
(215) 662-3228
Mailing address
3400 SPRUCE ST, 8 RAVDIN, PHILADELPHIA, PA 19104-4238
(215) 662-3228
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
—
PA
208000000X
Pediatrics Physician
—
PA
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
PA
2080P0202X
Pediatric Cardiology Physician
—
PA
Other
Enumeration date
12/26/2014
Last updated
11/19/2020
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