Organization
CLINICAL CARE ASSOCIATES OF THE UNIVERSITY OF PENNSYLVANIA HEALTH
Active
Organization
CLINICAL CARE ASSOCIATES OF THE UNIVERSITY OF PENNSYLVANIA HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTE L JACKSON (ENROLLMENT LEAD)
(215) 662-6187
Entity
Organization
Contact information
Practice address
250 KING OF PRUSSIA RD, 4TH FLOOR, RADNOR, PA 19087-5220
(610) 902-1720
Mailing address
250 KING OF PRUSSIA RD, 4TH FLOOR, RADNOR, PA 19087-5220
(610) 902-1720
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QA0000X
Adolescent Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1343994
BLUE SHIELD
PA
01
—
428207
BLUE SHIELD
PA
Enumeration date
11/02/2006
Last updated
11/19/2020
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