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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
3400 CIVIC CENTER BLVD, 2 EAST PAVILLION, PHILADELPHIA, PA 19104-5127
(215) 615-4949
Mailing address
3400 CIVIC CENTER BLVD, 2 EAST PAVILLION, PHILADELPHIA, PA 19104-5127
(215) 615-4949

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
PA

Other

Enumeration date
12/23/2014
Last updated
11/19/2020
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