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
1501 N CEDAR CREST BLVD, SUITE 110 LIVER TRANSPLANT, ALLENTOWN, PA 18104-2309
(215) 662-6200
Mailing address
1501 N CEDAR CREST BLVD, SUITE 110 LIVER TRANPLANT, ALLENTOWN, PA 18104-2309
(215) 662-6200
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
—
PA
208600000X
Surgery Physician
Primary
—
PA
Other
Enumeration date
05/25/2016
Last updated
11/19/2020
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