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
3701 MARKET ST, 8TH FLOOR, PHILADELPHIA, PA 19104-5502
(215) 662-6100
Mailing address
3701 MARKET ST, 8TH FLOOR, PHILADELPHIA, PA 19104-5502
(215) 662-6100
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
PA
207VE0102X
Reproductive Endocrinology Physician
Primary
—
PA
261QA0006X
Ambulatory Fertility Facility
—
PA
Other
Enumeration date
12/26/2014
Last updated
11/19/2020
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