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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 SPRUCE ST, ONE MALONEY, PHILADELPHIA, PA 19104-4206
(215) 662-4740
Mailing address
3400 SPRUCE ST, ONE MALONEY, PHILADELPHIA, PA 19104-4206
(215) 662-4740
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
—
NULL
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
08/25/2006
Last updated
11/20/2020
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