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General NPI Number Information
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NPI Number | 1225426331
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF PENN-MEDICAL GROUP
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Dates
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Enumeration Date | 12/26/2014
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 3400 SPRUCE ST 5 SILVERSTEIN BUILDING
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4238
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Country | US
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Telephone | 215-662-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 SPRUCE ST 5 SILVERSTEIN BUILDING
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4238
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Country | US
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Telephone | 215-662-2777
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Fax |
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Authorized Official
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Title or Position | ENROLLMENT LEAD
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Name | CHANTE L JACKSON
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Credential |
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Telephone | 215-662-6187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number |
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207YX0602X
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Taxonomy Name | Otolaryngic Allergy Physician
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License Number |
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number |
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State | PA
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