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
1001 CHESTERBROOK BLVD, 3RD FLOOR, BERWYN, PA 19312-3805
(610) 576-7500
Mailing address
1001 CHESTERBROOK BLVD, 3RD FLOOR, BERWYN, PA 19312-3805
(610) 576-7500
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
PA
Other
Enumeration date
12/22/2014
Last updated
11/19/2020
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