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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