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
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