Organization
UNIVERSITY OF PENN-MEDICAL GROUP
Active
Organization
UNIVERSITY OF PENN-MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY GRECO (PAYER ENROLLMENT MANAGER)
(223) 341-8516
Entity
Organization
Contact information
Practice address
3400 SPRUCE ST, 2 RHOADS PAVILION, PHILADELPHIA, PA 19104-4238
(215) 662-2737
Mailing address
3400 SPRUCE ST, 2 RHOADS PAVILION, PHILADELPHIA, PA 19104-4238
(215) 662-2737
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
207ND0900X
Dermatopathology Physician
Primary
—
PA
Other
Enumeration date
01/13/2015
Last updated
07/21/2026
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