Healthcare Provider Details

I. General information

NPI: 1225715378
Provider Name (Legal Business Name): THE CHILDRENS HOSPITAL OF PHILADELPHIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HERITAGE DR STE 820
POTTSTOWN PA
19464-9220
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

V. Phone/Fax

Practice location:
  • Phone: 610-326-8660
  • Fax: 610-326-8408
Mailing address:
  • Phone: 215-590-2897
  • Fax: 484-324-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1007709910131
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

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