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
3620 HAMILTON WALK, 1 JOHN MORGAN BLDG, PHILADELPHIA, PA 19104-4799
(215) 898-9095
Mailing address
3620 HAMILTON WALK, 1 JOHN MORGAN BLDG, PHILADELPHIA, PA 19104-4799
(215) 898-9095
Taxonomy
Speciality
Code
Description
License number
State
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
Primary
—
PA
207PH0002X
Hospice and Palliative Medicine (Emergency Medicine) Physician
—
PA
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
—
PA
Other
Enumeration date
12/26/2014
Last updated
11/19/2020
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