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, 5 SILVERSTEIN BUILDING, PHILADELPHIA, PA 19104-4238
(215) 662-2777
Mailing address
3400 SPRUCE ST, 5 SILVERSTEIN BUILDING, PHILADELPHIA, PA 19104-4238
(215) 662-2777
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
PA
207YS0123X
Facial Plastic Surgery Physician
—
PA
207YX0602X
Otolaryngic Allergy Physician
—
PA
207YX0901X
Otology & Neurotology Physician
—
PA
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
—
PA
Other
Enumeration date
12/26/2014
Last updated
11/19/2020
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up