# UNIVERSITY OF PENN-MEDICAL GROUP

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

## Provider details

- **NPI number:** 1760870893
- **Authorized official:** CHANTE L JACKSON (ENROLLMENT LEAD)
- **Authorized official phone:** (215) 662-6187

## Contact information

- **Practice address:** 1800 LOMBARD ST, GROUND FLOOR, PHILADELPHIA, PA 19146-1414
- **Practice address phone:** (215) 893-2600
- **Mailing address:** 1800 LOMBARD ST, GROUND FLOOR, PHILADELPHIA, PA 19146-1414
- **Mailing address phone:** (215) 893-2600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | PA | Yes |

## Other

- **Enumeration date:** 12/23/2014
- **Last updated:** 11/20/2020