# UNIVERSITY OF PENN-MEDICAL GROUP

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

## Provider details

- **NPI number:** 1679677975
- **Authorized official:** CHANTE L JACKSON (ENROLLMENT LEAD)
- **Authorized official phone:** (215) 662-6187

## Contact information

- **Practice address:** 3400 CIVIC CENTER BLVD, 2ND FLOOR, PHILADELPHIA, PA 19104-5127
- **Practice address phone:** (215) 615-5858
- **Mailing address:** 3400 CIVIC CENTER BLVD, 2ND FLOOR, PHILADELPHIA, PA 19104-5127
- **Mailing address phone:** (215) 615-5858

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RH0000X | Hematology (Internal Medicine) Physician | — | PA | — |
| 207RH0003X | Hematology & Oncology Physician | — | PA | Yes |
| 207RX0202X | Medical Oncology Physician | — | PA | — |

## Other

- **Enumeration date:** 09/08/2006
- **Last updated:** 11/19/2020