Organization
PENN MEDICINE-PMA
Active
Organization
PENN MEDICINE-PMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTE L JACKSON (PAYER SUPERVISOR)
(215) 662-6187
Entity
Organization
Contact information
Practice address
826 MAIN ST STE 100, PHOENIXVILLE, PA 19460-4459
(610) 933-8484
Mailing address
826 MAIN ST STE 100, PHOENIXVILLE, PA 19460-4459
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
Other
Enumeration date
09/30/2021
Last updated
09/30/2021
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