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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, 2ND FLOOR, PHILADELPHIA, PA 19104-5127
(215) 615-5858
Mailing address
3400 CIVIC CENTER BLVD, 2ND FLOOR, PHILADELPHIA, PA 19104-5127
(215) 615-5858
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
—
PA
207RH0003X
Hematology & Oncology Physician
Primary
—
PA
207RX0202X
Medical Oncology Physician
—
PA
Other
Enumeration date
09/08/2006
Last updated
11/19/2020
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