Organization
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTE L JACKSON (ENROLLMENT LEAD)
(215) 662-6187
Entity
Organization
Contact information
Practice address
240 S 40TH ST, PHILADELPHIA, PA 19104-6030
(215) 662-4000
Mailing address
240 S 40TH ST, PHILADELPHIA, PA 19104-6030
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
01/19/2021
Last updated
01/19/2021
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