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Organization

UNIVERSITY OF PENN-MEDICAL GROUP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHANTE L JACKSON (ENROLLMEMT LEAD)
(215) 662-6187
Entity
Organization

Contact information

Practice address
3400 SPRUCE ST, GROUND SILVERSTEIN BUILDING, PHILADELPHIA, PA 19104-4238
(215) 662-6698
Mailing address
3400 SPRUCE ST, GROUND SILVERSTEIN BUILDING, PHILADELPHIA, PA 19104-4238
(215) 662-6698

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
PA
207R00000X
Internal Medicine Physician
PA

Other

Enumeration date
12/23/2014
Last updated
11/20/2020
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