Basic Information
| Provider Information | |||||||||
| NPI: | 1871137091 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STC PEDIATRICS LLC | ||||||||
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| OtherOrganizationName: | ST. CHRISTOPHER'S PEDIATRIC ASSOCIATES DEVELOPEMENTAL MEDICINE - YARDL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13579 | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196123579 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 OXFORD VALLEY RD STE 1201 | ||||||||
| Address2: | |||||||||
| City: | YARDLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190677706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154275000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2019 | ||||||||
| LastUpdateDate: | 05/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | EHINGER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VP FINANCIAL OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 4846284681 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.