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NPI Code Detail

MEDICARE: STC PEDIATRICS LLC

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
1208000000XPediatrics Physician
2152W00000XOptometrist
3207WX0110XPediatric Ophthalmology and Strabismus Specialist Physician Physician
4152WP0200XPediatric Optometrist
5207W00000XOphthalmology Physician

General Provider Information

NPI Number : 1083258495
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 : 610-743-6049
Fax Number :
Provider Business Practice Location Address
First Line : 160 E ERIE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-1011
Country : US
Telephone Number : 215-427-8120
Fax Number :
Authorized Official
Title or Position : CFO
Name : BRIAN RAYME
Credential :
Telephone Number : 443-377-0616
Provider Enumeration Date : 10/30/2019
Last Update Date : 03/05/2026

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Directions to “STC PEDIATRICS LLC ” Practice Location

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