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General NPI Number Information
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NPI Number | 1598153603
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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 2 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 | 215-662-3340
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 SPRUCE ST 2 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 | 215-662-3340
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Fax |
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Authorized Official
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Title or Position | ENROLLMENT
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) 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 | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery 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 | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery 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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine 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 | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number |
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State | PA
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Taxonomy #7
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number |
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License Number State | PA
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Taxonomy #8
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State | PA
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Taxonomy #9
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State | PA
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Taxonomy #10
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | PA
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