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, 3RD FLOOR, PHILADELPHIA, PA 19104-5502
(215) 662-6035
Mailing address
3701 MARKET ST, 3RD FLOOR, PHILADELPHIA, PA 19104-5502
(215) 662-6035
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
—
PA
207VG0400X
Gynecology Physician
Primary
—
PA
207VM0101X
Maternal & Fetal Medicine Physician
—
PA
207VX0201X
Gynecologic Oncology Physician
—
—
261QA0005X
Ambulatory Family Planning Facility
—
PA
Other
Enumeration date
12/26/2014
Last updated
11/19/2020
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