# UNIVERSITY OF PENN-MEDICAL GROUP

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

## Provider details

- **NPI number:** 1609264720
- **Authorized official:** CHANTE L JACKSON (ENROLLMENT LEAD)
- **Authorized official phone:** (267) 456-2634

## Contact information

- **Practice address:** 3400 SPRUCE ST, 6 DULLES, PHILADELPHIA, PA 19104-4238
- **Practice address phone:** (215) 349-8310
- **Mailing address:** 3400 SPRUCE ST, 6 DULLES, PHILADELPHIA, PA 19104-4238
- **Mailing address phone:** (267) 456-2634

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | PA | Yes |
| 207LC0200X | Critical Care Medicine (Anesthesiology) Physician | — | PA | — |

## Other

- **Enumeration date:** 12/23/2014
- **Last updated:** 07/09/2024