| University Of Penn-medical Group | |
|
3400 Civic Center Blvd 2nd Floor South Pavillion Philadelphia PA 19104-5127 | |
| (215) 662-3606 | |
| Not Available |
| Full Name | University Of Penn-medical Group |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 3400 Civic Center Blvd, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Chante L Jackson (ENROLLMENT LEAD) |
| Authorized Official Contact | 2156626187 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| University Of Penn-medical Group 3400 Civic Center Blvd 2nd Floor South Pavillion Philadelphia PA 19104-5127 Ph: (215) 662-3606 | University Of Penn-medical Group 3400 Civic Center Blvd 2nd Floor South Pavillion Philadelphia PA 19104-5127 Ph: (215) 662-3606 |
| NPI Number | 1164810271 |
|---|---|
| Provider Enumeration Date | 12/26/2014 |
| Last Update Date | 11/19/2020 |
| Certification Date | 11/19/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164810271 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (Pennsylvania) | Primary |
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