MEDICARE: STC PEDIATRICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1033757661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STC PEDIATRICS LLC

Provider Business Mailing Address
First Line	:	PO BOX 13579
Second Line	:
City	:	READING
State	:	PA
Zip	:	19612-3579
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E HUNTING PARK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-6018
Country	:	US
Telephone Number	:	215-427-5000
Fax Number	:

Authorized Official
Title or Position	:	VP & CFO
Name	:	GARY CONNER
Credential	:
Telephone Number	:	484-628-8181

Provider Enumeration Date	:	12/13/2019
Last Update Date	:	12/13/2019

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