Healthcare Provider Details

I. General information

NPI: 1205916152
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OF PHILADLEPHIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BALTIMORE PIKE UNIT 10A
SPRINGFIELD PA
19064-2800
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

V. Phone/Fax

Practice location:
  • Phone: 610-604-0888
  • Fax: 610-604-0880
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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