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Organization

UNIVERSITY OF PENN - MEDICAL GROUP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHANTE L JACKSON (PROJECT LEAD)
(267) 207-7303
Entity
Organization

Contact information

Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(888) 722-3497
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(888) 722-3497

Taxonomy

Speciality
Code
Description
License number
State
207RA0002X
Adult Congenital Heart Disease Physician
207RC0000X
Cardiovascular Disease Physician
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
2084P0800X
Psychiatry Physician

Other

Enumeration date
12/04/2024
Last updated
12/04/2024
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