Healthcare Provider Details

I. General information

NPI: 1255923009
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OF PHILADELPHIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 SUSQUEHANNA RD
ABINGTON PA
19001-4612
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

V. Phone/Fax

Practice location:
  • Phone: 215-885-2790
  • Fax: 215-881-7140
Mailing address:
  • Phone: 215-590-5063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FABIAN STONE
Title or Position: VP REVENUE CYCLE
Credential:
Phone: 267-425-5765