Organization
UNIVERSITY OF PENN - MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTE L JACKSON (ENROLLMENT COOR)
(215) 662-6187
Entity
Organization
Contact information
Practice address
4923 STANTON OGLETOWN RD, NEWARK, DE 19713-2081
(215) 662-6200
(215) 662-2244
Mailing address
PO BOX 824320, PHILADELPHIA, PA 19182-4320
(215) 662-6187
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
Primary
—
—
207RG0100X
Gastroenterology Physician
—
—
Other
Enumeration date
10/12/2018
Last updated
11/19/2020
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