Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

University of Penn-Medical Group

Organization Plastic Surgery Physician · NPI 1194113118

University of Penn-Medical Group is a Plastic Surgery Physician in Philadelphia, Pennsylvania. Licensed in Pennsylvania. Registered with an NPI since 2014.

Licensed in
PA
In the registry since
2014
Specialties on file
2

Practice location Address checks out

3400 Civic Center Blvd South Pavillion 1st Fl
Philadelphia, PA 19104-5127
Phone: (215) 662-7300
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Plastic Surgery Physician (primary) Taxonomy 208200000X (PA)
Podiatrist Taxonomy 213E00000X (PA)

Record details

NPI number1194113118
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Chante Jackson — Enrollment Lead · (215) 662-6187
NPI enumeratedDecember 29, 2014
Last updated in NPPESNovember 19, 2020
Certification dateNovember 19, 2020
Mailing address3400 Civic Center Blvd, South Pavillion 1st Floor, Philadelphia, PA 19104-5127

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