Basic Information
| Provider Information | |||||||||
| NPI: | 1194084541 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMUELS | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34TH AND CIVIC CENTER BOULEVARD | ||||||||
| Address2: | THE CHILDREN'S HOSPITAL OF PHILADELPHIA | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155903174 | ||||||||
| FaxNumber: | 2155903053 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PARK ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065048901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175489759 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | MT208972 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | 2080P0205X | 064059 | CT | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
No ID Information.