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Organization
CLINICAL CARE ASSOCIATES OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYST
Active
Organization
CLINICAL CARE ASSOCIATES OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTE L JACKSON (ENROLLMENT LEAD)
(215) 662-6187
Entity
Organization
Contact information
Practice address
150 MONUMENT RD FL 4, BALA CYNWYD, PA 19004-1702
(610) 239-2871
(610) 239-2885
Mailing address
150 MONUMENT RD FL 4, BALA CYNWYD, PA 19004-1702
(610) 239-2871
(610) 239-2885
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
—
—
207PS0010X
Sports Medicine (Emergency Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
PA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
2084N0400X
Neurology Physician
—
—
208600000X
Surgery Physician
—
PA
208M00000X
Hospitalist Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100730664
—
PA
01
—
1343994
BLUE SHIELD
PA
01
—
428207
BLUE SHIELD
PA
Enumeration date
05/17/2006
Last updated
08/09/2023
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