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General NPI Number Information
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NPI Number | 1710184908
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Entity Type | Individual
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Provider Name | STEPHANIE BLACK M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 34TH STREET & CIVIC CENTER BLVD SUITE 9329
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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 | 215-590-1858
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Fax | 215-590-1415
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Provider Business Mailing Address
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Address Line | 100 E PENN SQ
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City | PHILADELPHIA
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State | PA
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Zip | 19107-3323
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Country | US
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Telephone | 267-425-9300
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 38050
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MT191494
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | MD443506
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License Number State | PA
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