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
1800 LOMBARD ST, GROUND FLOOR, PHILADELPHIA, PA 19146-1414
(215) 893-2600
Mailing address
1800 LOMBARD ST, GROUND FLOOR, PHILADELPHIA, PA 19146-1414
(215) 893-2600
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
PA
Other
Enumeration date
12/23/2014
Last updated
11/20/2020
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