# UNIVERSITY OF PENN-MEDICAL GROUP

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

## Provider details

- **NPI number:** 1700274727
- **Authorized official:** CHANTE L JACKSON (ENROLLMENT LEAD)
- **Authorized official phone:** (215) 662-6187

## Contact information

- **Practice address:** 3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
- **Practice address phone:** (215) 662-6503
- **Mailing address:** 3400 SPRUCE ST, 6 FOUNDERS, PHILADELPHIA, PA 19104-4238
- **Mailing address phone:** (215) 662-6503

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZC0500X | Cytopathology Physician | — | PA | — |
| 207ZN0500X | Neuropathology Physician | — | PA | — |
| 207ZP0007X | Molecular Genetic Pathology (Pathology) Physician | — | PA | — |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | PA | Yes |
| 207ZP0104X | Chemical Pathology Physician | — | PA | — |

## Other

- **Enumeration date:** 12/29/2014
- **Last updated:** 11/19/2020