Organization
CLINICAL CARE ASSOCIATES OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTE L JACKSON (ENROLLMENT LEAD)
(215) 662-6187
Entity
Organization
Contact information
Practice address
150 MONUMENT RD FL 4, BALA CYNWYD, PA 19004-1702
(610) 239-2871
(610) 239-2885
Mailing address
150 MONUMENT RD FL 4, BALA CYNWYD, PA 19004-1702
(610) 239-2871
(610) 239-2885
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
—
—
207PS0010X
Sports Medicine (Emergency Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
PA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
2084N0400X
Neurology Physician
—
—
208600000X
Surgery Physician
—
PA
208M00000X
Hospitalist Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100730664
—
PA
01
—
1343994
BLUE SHIELD
PA
01
—
428207
BLUE SHIELD
PA
Enumeration date
05/17/2006
Last updated
08/09/2023
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