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

University of Penn - Medical Group

Organization Psychologist · NPI 1194829739

University of Penn - Medical Group is a Psychologist in Philadelphia, Pennsylvania. Licensed in Pennsylvania. Registered with an NPI since 2006.

Licensed in
PA
In the registry since
2006
Specialties on file
3

Practice location Address checks out

3400 Spruce St 11 Gates
Philadelphia, PA 19104-4206
Phone: (215) 662-7772
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X
Psychologist Taxonomy 103T00000X (PA)
Pulmonary Disease Physician Taxonomy 207RP1001X

Record details

NPI number1194829739
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Chante Jackson — Enrollment Lead · (215) 662-6187
NPI enumeratedSeptember 12, 2006
Last updated in NPPESNovember 19, 2020
Certification dateNovember 19, 2020
Mailing address3400 Spruce St, 11 Gates, Philadelphia, PA 19104-4206

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