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 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 662-6503
Mailing address
3400 SPRUCE ST, 6 FOUNDERS, PHILADELPHIA, PA 19104-4238
(215) 662-6503
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
PA
207ZH0000X
Hematology (Pathology) Physician
—
PA
207ZN0500X
Neuropathology Physician
—
PA
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
—
PA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
PA
207ZP0104X
Chemical Pathology Physician
—
PA
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
—
PA
Other
Enumeration date
12/29/2014
Last updated
11/20/2020
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