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General NPI Number Information
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NPI Number | 1013115930
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Entity Type | Individual
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Provider Name | STEPHANIE FULLER M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 34TH & CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4399
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Country | US
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Telephone | 215-590-2708
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Fax | 215-590-2715
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone | 410-955-5000
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Fax | 410-500-4266
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | D0105511
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD420734
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | MD420734
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License Number State | PA
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