# UNIVERSITY OF PENN - MEDICAL GROUP

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

## Provider details

- **NPI number:** 1912014614
- **Authorized official:** CHANTE L JACKSON (ENROLLMENT LEAD)
- **Authorized official phone:** (215) 662-6187

## Contact information

- **Practice address:** 3400 SPRUCE ST, ONE MALONEY, PHILADELPHIA, PA 19104-4206
- **Practice address phone:** (215) 662-4740
- **Mailing address:** 3400 SPRUCE ST, ONE MALONEY, PHILADELPHIA, PA 19104-4206
- **Mailing address phone:** (215) 662-4740

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207SG0201X | Clinical Genetics (M.D.) Physician | — | NULL | Yes |
| 207SG0201X | Clinical Genetics (M.D.) Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 08/25/2006
- **Last updated:** 11/20/2020