Organization
UNIVERSITY OF PENN-MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTE L JACKSON (ENROLLMENT)
(215) 662-6187
Entity
Organization
Contact information
Practice address
3400 SPRUCE ST, 2 SILVERSTEIN BUILDING, PHILADELPHIA, PA 19104-4238
(215) 662-3340
Mailing address
3400 SPRUCE ST, 2 SILVERSTEIN BUILDING, PHILADELPHIA, PA 19104-4238
(215) 662-3340
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
PA
207X00000X
Orthopaedic Surgery Physician
Primary
—
PA
207XS0106X
Orthopaedic Hand Surgery Physician
—
PA
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
—
PA
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
PA
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
PA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
PA
207XX0801X
Orthopaedic Trauma Physician
—
PA
208100000X
Physical Medicine & Rehabilitation Physician
—
PA
208200000X
Plastic Surgery Physician
—
PA
Other
Enumeration date
12/26/2014
Last updated
11/19/2020
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