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
554 N DUKE ST, 3RD FLOOR, LANCASTER, PA 17602-2225
(215) 662-6200
(215) 662-2244
Mailing address
554 N DUKE ST, 3RD FLOOR, LANCASTER, PA 17602-2225
(215) 662-6200
(215) 662-2244
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
Primary
—
PA
208600000X
Surgery Physician
—
PA
2086S0129X
Vascular Surgery Physician
—
PA
Other
Enumeration date
04/04/2016
Last updated
11/20/2020
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